Full term normal delivery following suicidal hanging

A 23-year-old woman was found hanging from the ceiling of her house by the neighbours. A live healthy male newborn baby was found lying on the ground with the umbilical cord in situ and placenta inside the uterus. The woman, a primigravida, married 3 years back, was in labour since morning. Her husband had gone out to call for some help to conduct delivery. During the absence of her husband, the wife bolted the door from inside and committed suicide by hanging. During this process she delivered a healthy male baby. This may be the first documentation of a pregnant woman delivering a healthy baby successfully, following suicide by hanging.     

Two unusual cases of suicide by hanging

Two unusual cases of suicide by hanging are described, in the first case the deceased's left hand tied to the left thigh with the head and face covered by a heavy winter coat. In the second case the deceased's hands were tied behind his back.     

头颈外伤致椎动脉破裂伴颅底蛛网膜下腔出血1例尸检分析

头颈外伤致椎动脉破裂伴颅底蛛网膜下腔出血１例尸检分析易旭夫，刘敏，吴家Ｓｕｂａｒａｃｈｎｏｉｄｈａｅｍｏｒｒｈａｇｅｄｕｅｔｏｒｕｐｔｕｒｅｏｆｔｈｅｖｅｒｔｅｂｒａｌａｒｔｅｒｙａｓｓｏｃｉａｔｅｄｗｉｔｈｈｅａｄｔｒａｕｍａ：ｒｅｐｏｒｔｏｆｏｎ...     

Neck markings and fractures in suicidal hangings

Over a 10-year period in which both a retrospective and prospective study of suicidal hangings was made, fractures of the thyroid cartilage alone, or the hyoid bone alone, or of both together were noted in 20% of the cases. In the prospective study, an incidence of 46% was found. This contrasts sharply with the incidence of 15% in the retrospective study. This wide discrepancy indicates the need for longer periods of a controlled prospective study by properly trained prosectors. Fractures were found in all age groups above 19 years of age and occurred whether suspension was complete or incomplete, whether the ligature was soft or hard, narrow or wide, and whether decedents did or did not jump from a platform. The higher incidence of fractures occurring among women is unexplained. The presence of reddish or pink bands or linear streaks (with or without superimposed abrasions) along one side of the neck, separated by bands of pale skin, canting upwards towards the back of the neck and revealing the imprint of a folded cloth permits the diagnosis of ante-mortem hanging in the absence of very strong proof to the contrary. As in any type of Medical Examiner's case, a knowledge of the circumstances and investigation of the scene are required before a final determination of the cause and manner of death can be considered.     

A case of suicidal hanging in an automobile

A case of suicidal hanging inside an automobile is presented. To our knowledge, hanging has not been previously reported as a cause of death in a motor vehicle driver. The causes of death in automobile-related suicides are discussed.     

Decapitation as a result of suicidal hanging

A report is presented on a 47 year old man who committed suicide by hanging himself from a staircase bannister of an apartment house. The man, weighing 144 kg jumped with the noose of a 2 cm thick and 2 m long hemp rope around his neck and was completely decapitated. Death from typical "normal" suicidal hanging is usually due to cerebral ischaemia caused by compression of the carotid (and vertebral) arteries. Except for bleeding at the clavicular insertions of the sternocleidomastoid muscles there are only occasional injuries to the cervical soft parts or hyoid bone and/or laryngeal cartilage. A fall with a noose around the neck, on the other hand, is associated with more frequent injuries to cervical structures through additional axial traction and radial shearing forces of the tightening noose. Complete decapitation can occur in rare cases under extreme conditions (heavy body weight, inelastic and/or thin rope material, fall from a great height).     

A case of suicidal hanging staged as homicide

Suicides staged as homicides are rarely encountered by crime scene investigators. The case of one such staged homicide is presented in which the victim used restraints during a hanging. No other cases of suicidal hangings staged as homicides could be found in the forensic literature. Similar cases should be reported so additional data can be gained from these deaths to help reveal indicators of suicide rather than homicide.     

Agonal sequences in a filmed suicidal hanging: analysis of respiratory and movement responses to asphyxia by hanging

The forensic literature on the pathophysiology of human hanging is still limited. Therefore, forensic pathologists often feel uncomfortable when confronted with related questions. Here presented is the filmed suicidal hanging of a 37-year-old man. This recording allows a unique analysis of agonal movement sequences: loss of consciousness (13 sec), convulsions (15 sec), decortication rigidity (21 sec), decerebration rigidity (46 sec), second decortication rigidity (1 min 11 sec), loss of muscle tone, (1 min 38 sec) and last isolated muscle movement (4 min 10 sec). As for respiratory responses, very deep respiratory attempts started at 20 sec. Respiratory movements progressively decreased and completely stopped at 2 min. Despite the fact that extending the presented data on all cases of hanging asphyxia would be a mistake, this case gives a very interesting insight into movement and respiratory response to asphyxia by hanging.     

Death in bathtub revisited with molecular genetics: a victim with suicidal traits and a LQTS gene mutation

A 44-year-old woman with a medical history of mental disorders and previous suicidal behaviour was found in a bathtub and pronounced death few minutes later despite of resuscitation attempts. After police investigation and on the basis of autopsy findings, the death was classified as suicide drowning. Retrospective examination of clinical data revealed, a prolonged rate-corrected QT-interval (QTc: 468 ms) 3 months before death. Post-mortem (PM) DNA analysis disclosed KCNH2_FIN mutation for the long-QT syndrome (LQTS). The value of PM molecular screening for LQTS is emphasised, especially for victims of putative drowning.     

Morphometric studies of the vertebral artery in infants and small children

The internal circumference of the vertebral artery and the cross-sectional area of its tunica media were measured planimetrically at three different topographical sites in 48 cases of sudden infant death syndrome (SIDS) and 18 reference cases. Based on preliminary determination of the error of measurement, both groups studied showed significant differences between sides. As the degree of differences is often marked, impressive haemodynamic consequences can be expected. The findings are discussed with regard to SIDS.     

Traumatic dissection of the vertebral artery in a toddler following a short fall

Spontaneous subarachnoid haemorrhage (SAH) in children is uncommon, but is sometimes seen after rupture of aneurysms, and in different disorders. Traumatic SAH is common after serious accidental head injury, but is also reported after child abuse with vigorous shaking. To avoid unnecessary accusations of innocent care givers, it is important not to misinterpret the findings as abusive head trauma in small children with SAH. In the presented case, a nearly two-year-old girl was brought to the hospital after a fall witnessed by her father. The girl was unconscious, with elevated intracranial pressure, SAH and bilateral retinal haemorrhage (RH). She was pronounced dead after 9h. Premortem angiography revealed a dissection of the right vertebral artery, and postmortem examination revealed a traumatic lesion deep in the neck, at the base of the skull. Cerebral edema, in combination with SAH and RH, is highly suggestive of abusive head trauma. However, no external lesions, no skeletal lesions, especially no long bone metaphyseal lesions, or subdural haematomas occurring at the same time as SAH, were found. There was no report of previous child abuse in the family. Based on the radiological and postmortem findings, we believe that an accidental fall caused a blunt force trauma with a subsequent dissection of the right vertebral artery. To our knowledge, accidental tear of one of the vertebral arteries, leading to SAH in a toddler, has previously not been described. Child abuse is an important exclusion diagnosis with serious legal implications.     

Periadventitial extracranial vertebral artery hemorrhage in a case of shaken baby syndrome

We report a case of a two-month-old boy who became unresponsive in the sole custody of his father. Resuscitation efforts on route to the hospital were able to restore the infant's heart beat. However, neurologic function never recovered. Autopsy revealed massive cerebral edema, recent subdural, and subarachnoid hemorrhages, bilateral retinal hemorrhages, and cervical spine ligament hemorrhages. Separation of individual cervical vertebrae showed extensive, bilateral, periadventitial vertebral artery hemorrhages between C1 and C4, with corresponding luminal compression of the vertebral arteries. The importance of this previously unreported phenomena of periadventitial vertebral artery hemorrhage in the setting of shaken baby syndrome is discussed.     

Carotid and vertebral artery circulation in forearm choke holds in Doppler sonography

By means of continuous wave doppler the effect of two choke holds (Carotid sleeper, Nami-juji-jime) on the carotid and vertebral arteries was investigated. For both choke holds, which are characterized by pressure on lateral parts of the neck, we found an obstruction up to a complete stop of flow. The degree of obstruction depended on the direction of force. The vertebral artery can be compressed between the subclavian artery and the foramina transversaria, therefore it was most effective to press on the lower neck. Tensing the neck muscles can reduce the effect of choking.     

A proposed dissection procedure for vertebral arteries in forensic pathology

Vertebral artery removing constitutes a significant forensic pathology challenge. Dissection techniques during head-neck autopsy are based on anterior approach, a difficult method, which is unable to assess the transverse part of the artery. This work presents an original and simple method for dissecting vertebral arteries by a posterior approach, opening the vertebroarterial canal through the spinal canal without any special equipment. Once the spinal cord is removed, the transversarium foramens are opened by an internal cut at the pedicle and an external cut at the transverse process. This enables us to visualize vertebral arteries in its entirety. The method improves both the examination of the upper extracranial segment of the vertebral artery and the neuropathological study when arterial injury is suspected. Applying this method routinely is both feasible and useful in suspected cases of vertebral artery trauma and could contribute to assess more precisely the actual incidence of this injury.     

Characterization of lesions in hanging deaths

Hanging is a common method of committing suicide and a routine task in medico-legal autopsies. The hanging mark is the most relevant external sign and its characteristics are well known, but, for unknown reasons, there are major differences in reports on internal findings. We retrospectively studied 228 consecutive cases of hanging deaths. A complete standard autopsy was performed for every case. We investigated the association between the characteristics of the hanging mark and the frequency of bone, cartilage, soft tissue, and vascular injuries with the mode of suspension. Most cases (75.3%) presented some kind of bone or cartilage fracture, but these were unrelated to any of the variables studied. Vascular lesions are clearly more infrequent: intimal injuries were found in the carotid artery (9.1%), the jugular vein (2.2%), and ruptures of the carotid adventitial layer (21.7%). These could be partially associated with the use of a hard fixed noose and body weight.     

Analysis of neck injuries in hanging

Retrospective study of suicidal hangings was made on 175 cases (133 male victims, 42 female victims) for a 5-year period. The mean age was 47.33 +/- 17.51 years. The sample was divided in 4 groups according to the position of the ligature knot (anterior, right, left, and posterior hanging). The authors analyzed all visible injuries of soft tissues and bones and cartilage of the neck, and in 150 cases (85.7%), we established that there was at least one injury of these structures (hematoma or fracture for example). The most frequent injury was to sternocleidomastoid muscles. Fracture of throat skeleton was detected in 119 cases (68%). The proportion of fractures increases with age of the deceased. There was no clear correlation between frequency of neck injuries and type of hanging.     

A biomechanical study of the human vertebral artery with implications for fatal arterial injury

We studied the biomechanical behaviour of ring and strip specimens from along the length of 18 vertebral arteries taken from 16 subjects aged 28-90 years, in order to consider some of the factors which may play a role in vertebral artery rupture. The method was chosen to allow a comparison between circumferential distension (ring samples) and longitudinal extension, (strip samples). The samples were extended between the jaws of a tensile testing apparatus until the specimen broke and a number of biomechanical parameters were derived. These were the percentage extension to break, the tensile strength, Young's modulus and the peak load. There were a number of important findings. The vertebral artery was shown to be susceptible to longitudinal stretching with a number of strip samples breaking when extended by as little as 16-20%. The tensile strength and load at peak of the strip specimens were correspondingly lower than for the ring samples. Marked intersubject variations were shown for all these parameters and prominent changes in behaviour occurred along the vertebral artery. This study indicates that the artery may be susceptible to head and neck movements which cause the vessel to stretch, and intersubject variations in behaviour may be one important explanation for the marked differences in outcome which appear to exist in subjects who suffer broadly similar head and neck insults.     

Further observations on the speed of death in hanging

Given that most fatal hangings are suicidal and occur in locations that have been selected to conceal this activity (thus maximizing the chances of a lethal outcome), there has been very little corroboration of the speed with which unconsciousness and death may occur. A 35-year-old male is reported who committed suicide by hanging immediately after talking to his spouse. Police investigations confirmed her reliability as a witness indicating that lethal anoxia in this case had occurred within a very short time (most likely in less than 1 min) of suspension. The speed with which death may result from hanging not only gives an insight into fatal pathophysiological mechanisms, but also provides useful information for situations where a lethal outcome is to be avoided, or is not intended. For example, individuals at risk of suicide who are being monitored in institutional facilities need to be constantly under direct visual surveillance as significant hypoxia can be rapidly induced, parents and caregivers with infants and children in potentially unsafe sleeping environments need to realize how swiftly death or irreversible anoxic brain damage may occur from neck compression, and those who engage in recreational asphyxia should be informed just how quickly a fatal outcome may ensue.     

Fractures of the axis caused by hanging

Prerequisities for fractures of the neural arch of the axis in the region of the isthmus (hangman's fracture) during hanging are considered to be a long drop and a submental knot. A case is presented showing that hangman's fracture arising in hanging can result from stretching of the neck combined with anteroflexion of the head.