Delayed bilateral internal carotid artery thrombosis following accidental strangulation

Kiani, Soroosh; D, Simes

doi:10.1093/oxfordjournals.bja.a013484

Cited by 26 publications

(17 citation statements)

References 3 publications

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“…There are four generally recognised mechanisms that cause death from strangulation: Anoxia from occlusion of the arteries. The pressure required varies with the surface area compressed, and the depth and position of the force, but it has been estimated that only 11 psi or 3.5 kg is all that is required (the average male handshake is 80–100 psi) . Occlusion of the vertebral arteries depends on the position of the pressure, not the amount of pressure (at the base of the neck, before they are protected by the transverse processes of the cervical vertebrae).…”

Section: What Does the Literature Tell Us?mentioning

confidence: 99%

“…Congestion, followed by anoxia from venous occlusion. Occlusion of the veins requires an estimated 4 psi, or 2 kg . Congestion of the blood flow through the head and face results in the blood leakage from capillaries and small vessels, resulting in petechial bruises in soft tissues, including the brain. Hypoxia from occlusion of the airway.…”

Section: What Does the Literature Tell Us?mentioning

confidence: 99%

“…In 2011, the Northern Territory Government guideline on hanging (including strangulation without a drop by a ligature) estimated the rate of damage to the carotid artery at 5% . Furthermore, there are numerous case reports of unilateral and bilateral carotid artery dissections and jugular venous thrombus following NFS, including manual strangulation . For example, in 2005, a woman with no external signs, presented to an ED 2 days after a manual NFS event complaining of headache.…”

Section: Injuries From Strangulationmentioning

confidence: 99%

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

Boos

2019

Emerg Medicine Australasia

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Non‐fatal strangulation (NFS) can be a cause of severe injury. However, the prevalence and rates of injuries from NFS are unknown, as few victims present to medical attention after strangulation. As up to 40% of fatal strangulations have no external signs, and the majority of surviving victims have few or minor injuries, finding those people severely injured remains challenging. The majority of the evidence regarding NFS is largely based on case reports and case series with no robust studies estimating rates of injuries or the best investigation tools. The injuries that are reported make clear that strangulation is a potentially lethal form of injury that should not be ignored in those presenting having been strangled, or in those presenting with neurological symptoms, including strokes, seizures and vascular abnormalities. 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). This article summarises the injuries that can occur following strangulation and discusses the quality of the evidence thus far.

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Section: What Does the Literature Tell Us?mentioning

confidence: 99%

Section: What Does the Literature Tell Us?mentioning

confidence: 99%

Section: Injuries From Strangulationmentioning

confidence: 99%

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

Boos

2019

Emerg Medicine Australasia

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“…While most fishermen who are dragged overboard have had their limbs entangled in lines or nets, on occasion this may involve the neck, with death resulting from a combination of immersion and neck compression. 5 Lethal consequences of fish hooks are more often found within the veterinary literature and involve cases of sea bird or mammal impalement, entanglement with fishing line or ingestion with gut perforation. 6 Several problems arise in the forensic evaluation of fishing industry deaths.…”

Section: Discussionmentioning

confidence: 99%

Lethal fish hook attachment – An unusual occurrence

Byard

2013

Journal of Forensic and Legal Medicine

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“…19 Motor vehicle accidents are consistently reported to be the most common cause of BCI, with their contribution to reported cases ranging from 45% to 96%. [2][3][4][5][6]8,11,[20][21][22][23][24] Other frequently recognized causes include falls from a height, near-hanging, strangulation, 25,26 and sporting injuries. There are numerous case reports describing blunt carotid injury after trivial trauma, including riding a mountain bike, 27 airbag deployment 28 (without impact) and even playing a wind instrument.…”

Section: Mechanism Of Injurymentioning

confidence: 99%

Blunt carotid artery injury

Nunnink

2002

Emergency Medicine

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Blunt carotid artery injury is an uncommon injury with a potentially devastating outcome. Although treatment is often unhelpful for an established neurologic deficit, there is frequently a delay between the episode of trauma and the onset of neurology. This delay provides a window of opportunity where early detection and intervention may significantly improve outcome and prevent lifelong morbidity in a generally young trauma patient population. This paper will review the literature regarding incidence, outcome, treatment options and optimal methods of diagnosis for this lesion. The following synopsis of a case seen at Royal Perth Hospital Emergency Department illustrates several of the classical features of blunt carotid injury, including delayed presentation and pattern of associated injuries. The patient, a 19‐year‐old female, presented following a single vehicle motor crash. On arrival she had a Glasgow Coma Scale (GCS) of 14 with no focal neurologic deficit. Multiple injuries were identified, including a large scalp laceration, a compound fracture of the mandible, pneumothorax, sternal fracture, subcapsular haematoma of the liver, and a knee laceration. Initial computed tomography (CT) scan of the head was normal. Twenty hours after the motor vehicle accident the patient's conscious state deteriorated to GCS 9. Repeat CT head demonstrated changes consistent with a left middle cerebral artery infarct. Cerebral angiography revealed traumatic dissection of the left internal carotid artery with complete occlusion of the lumen just distal to its origin. After 13 days in the intensive care unit and 2.5 months in the rehabilitation unit, she was discharged with a persistent severe receptive and expressive aphasia, as well as a dense right hemiparesis. She is now living at home with community supports.

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Delayed bilateral internal carotid artery thrombosis following accidental strangulation

Cited by 26 publications

References 3 publications

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

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

Lethal fish hook attachment – An unusual occurrence

Blunt carotid artery injury

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