Cervical Arterial Injury After Strangulation—Different Types of Arterial Lesions

Abstract

After strangulation, cervical arterial injuries (CAI) are uncommon. We report three unusual cases where strangulation induced immediate stroke. CAI were examined using brain CT scan and Doppler ultrasonography in the three cases and then by autopsy in one of the victims. One of the two victims who survived the attempted strangulation had a unilateral carotid dissection, whereas in the other victim, no arterial dissection or thrombosis was observed. As regards the deceased victim, the autopsy confirmed the bilateral dissection showed on CT scan and Doppler ultrasonic examination and revealed that both carotid arteries were dilated up to two times the normal diameter. Microscopic examination showed a major bilateral hemorrhagic dissection of the media with obliterating fibrous endarteritis lesions associated with inflammatory damage. CT scan with arteriography does not demonstrate all the different types of arterial injury, particularly atheromatous embolism, direct compression, or prolonged spasm. Thus, traditional autopsy remains an essential forensic tool after strangulation to show the type of CAI.

Review article: Non‐fatal strangulation: Hidden injuries, hidden risks

“…In total, 68 relevant articles were found. Of these, 22 were case reports (of up to three cases per article), and 22 were case series involving both non‐fatal and fatal strangulation . However, three articles were written about one case series of 300, and four involved the analysis of a growing list of videos of autoerotic asphyxia.…”

“…The safety implications of strangulation are also important as it can be a prelude to homicide. A search of the literature was carried out with the following terms: Nonfatal strangulation (10), Nonfatal strangulation (17), 'Strangulation injuries' (19), 'Manual strangulation' (92)laboratory testing eliminated, and 'choking game'. The PubMed database was used first, followed by the collections of Monash University and the Strangulation Institute (as some articles were too old to find electronically).…”

Injuries of Women Surviving Intimate Partner Strangulation and Subsequent Emergency Health Care Seeking: An Integrative Evidence Review

“…Strangulation, defined as external pressure to the neck closing blood vessels and/or air passages and depriving one of oxygen, 1 has been equated to the torture of drowning and water boarding. 2 Non-fatal intimate partner strangulation (NF-IPS) is increasingly being acknowledged as a serious risk factor for negative health outcomes like carotid artery dissection, 3–6 stroke, 4,5,7 seizures, 4 PTSD, 6,8 anxiety and depression, 6–9 as well as future lethal violence, heightening women’s risk by 7-fold for being murdered by a partner. 10 In the most recent National Intimate Partner and Sexual Violence Survey (NISVS), 11 approximately 10% of female respondents report surviving IPS at least once in their lifetimes, extrapolating to ~11 million U.S. adult women.…”

Tinnitus 3 Years After Strangulation

“…There are also several reports of carotid artery dissection after strangulation (Clarot et al, 2005;Le Blanc-Louvry et al, 2013;Tieulie et al, 2003). Contrary to our patient and the patient of Clarot et al (2005) Tieulie et al (2003) presented two women who were victims of homicidal strangulation 8 and 6 years before the diagnosis of carotid dissection.…”