Strangulation is the application of external pressure to the neck, which can quickly lead to severe injury or death. This force restricts blood flow and/or airflow, impacting the brain’s ability to function. It is categorized primarily as manual (using hands) or ligature (using an object like a cord or rope). The danger lies mainly in the immediate disruption of blood flow to and from the brain, which can cause unconsciousness in seconds.
How Strangulation Causes Harm
The compression of blood vessels rapidly starves the brain of oxygen. Minimal pressure, approximately 4.4 pounds, is sufficient to compress the jugular veins that drain deoxygenated blood from the head. This compression causes blood to rapidly back up in the brain, leading to cerebral congestion and subsequent loss of consciousness.
Slightly more force, around 11 pounds of pressure, can occlude the carotid arteries, which supply oxygenated blood to the brain. When both the veins and arteries are compressed, unconsciousness can occur within 5 to 15 seconds. The trachea, or windpipe, requires significantly more force, roughly 33 pounds, to completely close. This means vascular compression is generally the faster and more common mechanism of harm. Pressure on the neck can also stimulate the carotid sinus, potentially triggering a sudden drop in heart rate and blood pressure, which may lead to cardiac arrest.
Visible Physical Indicators
Visible signs of injury are only present in approximately half of all cases. When present, small, pinpoint red or purple spots, known as petechiae, are a common indicator. These spots are tiny hemorrhages caused by ruptured capillaries on the face, eyelids, or behind the ears due to venous congestion.
Marks on the neck vary widely, ranging from superficial abrasions or scratches to deep bruising. Manual strangulation may leave finger contusions or thumb impressions, while a ligature often leaves a distinct horizontal groove or mark. The skin on the face, eyes, and neck may appear flushed or unnaturally red due to the pooling of blood above the compression point.
Immediate changes in voice are frequently observed, including hoarseness, a raspy quality, or complete inability to speak. This change, medically termed dysphonia, suggests trauma or swelling to the larynx or vocal cords. Victims may also exhibit bloodshot eyes, or subconjunctival hemorrhage, where blood vessels burst on the white part of the eye due to pressure.
Symptoms That Appear Later
Internal injuries may not manifest for hours or even days following the event. Swelling in the soft tissues of the neck can progressively worsen, leading to delayed airway obstruction up to 36 hours later. Forceful compression can also result in fractures of delicate structures in the neck, such as the hyoid bone or the cartilage around the larynx.
Neurological symptoms are a significant concern and can mimic a traumatic brain injury or stroke. These effects include persistent headache, dizziness, difficulty concentrating, and memory loss, often related to the temporary lack of oxygen to the brain. Damage to the carotid artery lining, known as a dissection, can cause a clot to form. This clot may later travel to the brain and cause a full stroke days or weeks after the incident.
Other internal problems include difficulty swallowing (dysphagia), nausea, and vomiting. Involuntary loss of bowel or bladder control may also occur during the episode.
The Need for Medical Assessment
Any person who has been strangled requires immediate and thorough medical evaluation. Since visible signs are often absent or minimal, a lack of external marks does not rule out severe internal damage. The greatest risk is the potential for delayed complications, such as a stroke from an arterial dissection or airway closure from worsening internal swelling.
Healthcare professionals look for hidden injuries using specific diagnostic tools. Assessments may include imaging scans to check for damage to neck arteries and veins, or specialized exams to check the function of the vocal cords and larynx. Seeking professional care is the only way to detect and manage these serious internal injuries before they become fatal.