Strangulation is defined as the obstruction of blood vessels and/or airway by external pressure to the neck which leads to a decreased oxygen supply to the brain.1 Strangulation leads to obstruction of the arteries and hypoxia. Obstruction of the veins can lead to increased cerebral blood pressure and ‘stagnant hypoxia’ which can lead to spinal cord damage, pressure on carotid body or damage to the intima of blood vessels which can lead to thrombus or dissection. There are often no external injuries to be seen.1

Pressure to the neck can be applied via one or two hands (manual strangulation), by a forearm from behind (chokehold strangulation), or using a ligature or object. Pressure can be gradually exerted, sudden or on/off in nature. This can lead to loss of consciousness followed by anoxic seizures, urinary incontinence and faecal incontinence. It takes very little pressure to occlude important structures in the neck, for example, pressure required to occlude structures in the …