Strangulation is a serious assault involving external pressure on the neck. This pressure impedes breathing and restricts blood flow to and from the brain. Even brief compression can lead to severe oxygen deprivation. Understanding potential indicators is important, as visible marks may be minimal or absent, yet serious internal damage can occur.
Immediate External Indicators
Immediately following strangulation, visible signs may appear on the body. The neck might show redness, abrasions, or bruising, sometimes reflecting finger marks or a ligature’s impression. These marks can range from subtle to distinct.
The face and head can also exhibit signs due to increased capillary pressure. Petechiae, small pinpoint red or purple spots, may be noticeable on the scalp, face, eyelids, or behind the ears. Facial swelling or a flushed appearance can also occur.
The eyes often show indicators like petechiae on the eyeballs or bloodshot eyes, known as subconjunctival hemorrhages. These hemorrhages result from burst blood vessels over the white part of the eye due to pressure increases. Pupils may appear dilated or constricted.
Beyond physical marks, immediate behavioral or physical changes can be observed. These include gasping, shallow or difficult breathing, or other respiratory distress. A person might also display signs of struggle, agitation, or altered consciousness, including temporary loss of awareness.
Delayed and Subtle External Indicators
Some signs of strangulation may not be immediately apparent, developing hours or days after the incident. Voice changes are common, ranging from hoarseness (dysphonia) to difficulty speaking or complete loss of voice. These changes often stem from injury to the larynx or surrounding structures.
Throat discomfort, such as difficulty swallowing (dysphagia), painful swallowing (odynophagia), or a persistent sore throat, can emerge later. Neck pain and stiffness, along with tenderness or restricted movement, are also potential delayed symptoms.
Bruising on the neck or other areas may not surface until several hours or a day or two following the event. Neurological symptoms, which are external manifestations of internal impact, can include dizziness, lightheadedness, persistent headaches, confusion, or memory issues. Vision changes, such as blurred vision, seeing “stars,” or tunnel vision, may also be reported.
Internal Consequences and Hidden Risks
Strangulation can inflict severe internal damage, even when external signs are minimal or absent. A primary concern is oxygen deprivation (hypoxia or anoxia), where restricted blood flow to the brain causes cellular damage. Brain cells begin to die within minutes without continuous oxygen.
This lack of oxygen can lead to brain injury, potentially causing swelling (cerebral edema), stroke, or permanent neurological impairment. Such injuries can result in long-term difficulties with movement, vision, memory, speech, and cognitive function.
Structures within the neck are also vulnerable to damage. This includes injury to the trachea (windpipe), larynx (voice box), or the hyoid bone, a small bone located at the base of the tongue. The carotid arteries and jugular veins, which are responsible for blood flow to and from the brain, can also be injured.
Delayed complications pose a significant risk, particularly blood clot formation in damaged vessels. These clots can travel to the brain, causing a stroke days, weeks, or months after the incident. Aspiration of stomach contents if vomiting occurs during the assault can lead to pneumonia.
Why Medical Attention is Crucial
Recognizing any signs of strangulation, whether immediate, delayed, or subtle, underscores the need for prompt medical evaluation. Many severe injuries from strangulation are internal and not visible on the surface. These hidden injuries can pose a life-threatening risk even when a person appears to be recovering.
Symptoms and complications can manifest hours or days after the event. Medical professionals identify internal damage through specialized examinations and diagnostic tests, such as imaging studies and neurological assessments. This assessment is essential for detecting potential delayed complications and providing intervention to mitigate long-term health consequences.