AUTONOMOUS NERVOUS SYSTEM-RELATED VITAL REACTIONS IN SHORT-DROP HANGINGS
Keywords:
Hanging, Suicide, Autopsy, Forensic Pathology, Vital reaction, Autonomous nervous system and ANS, Hypersalivation, Agony, Facies sympathique, Myosis, Ptosis
Abstract
There are many anatomopathological signs forensic pathologists take into account in autopsy evaluation of deaths by hangings, having in mind one of the most important tasks: to prove the person was alive at the moment of suspension. Forensic medicine textbooks describe in detail many routinely observed findings, but some phenomena were not of particular interest. This may be, of course, due to the unreliability or impracticability of the finding interpretation. Nevertheless, some signs of vitality that may be related to the autonomous nervous system (ANS) in hangings could be useful. We may consider these as general ANS-related vitality phenomena, associated with the agonal sequence, and those directly associated with the specific neck region injury by the ligature. The former is primarily the non-specific increase in blood catecholamine levels and the hypersalivation with saliva dropping on the face skin from the lips’ angles, which is associated with agonal convulsions and deep terminal “abdominal” respirations. The latter, probably more interesting, is the so-called facies sympathique: the lesion of the sympathetic fibers in the neck region may lead to myosis and partial upper eyelid ptosis on the side of the lesion. However, this sign was not of great interest in research and remained incompletely understood regarding the postmortem appearance interpretation. This demands further studies but, if properly analyzed, may prove useful, as proof of vitality and for reconstructing the event, too, in case the other findings are subtle or absent.
References
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34. Hoffmann JM, Elger CE, Kleefuss-Lie AA. The localizing value of hypersalivation and postictal coughing in temporal lobe epilepsy. Epilepsy Res. 2009;87(2-3):144-7.
35. Leibetseder A, Eisermann M, LaFrance WC, Nobili L, von Oertzen TJ. How to distinguish seizures from non‐epileptic manifestations. Epileptic Disorders. 2020;22(6):716–38.
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38. Doberentz E, Madea B. Traumatic carotid sinus reflex and postmortem investigation of the glomus caroticum in cases of pressure to the neck. In: Rutty, G, editor. Essentials of Autopsy Practice: Reviews, Updates and Advances. Switzerland AG: Springer Nature; 2020. p.67–88.
39. Arslan MN, Melez DO, Gülbeyaz H, Hosukler B, Sam B, Koç S. Possible death mechanisms other than respiratory asphyxia in a suicidal hanging case. Rom J Leg Med. 2013;21(3):169-72.
40. Criminocorpus. Archives de l’anthropologie criminelle (tome 14 ; 1899) — Page 178 | [Internet]. France: Musée Criminocorpus [cited 2024 Jan 29]. Available from: https://criminocorpus.org/fr/bibliotheque/page/9565/
41. Mtui E, Gruener G, Dockery P, FitzGerald MJT. Fitzgerald’s clinical neuroanatomy and neuroscience. 7th ed (International Edition). Philadelphia, PA: Elsevier; 2015.
42. Minovici N. Études sur la pendaison (1905). Paris, France: Hachette Livre Bnf. 2020;
43. Đurić M, editor. Anatomija glave i vrata. Belgrade, Serbia: University of Belgrade – Faculty of Medicine, CIBID; 2020.
44. Flaherty PM, Flynn JM. Horner Syndrome Due to Carotid Dissection. J Emerg Med. 2011;41(1):43–6.
45. Chan CCK, Paine M, O’Day J. Carotid dissection: a common cause of Horner’s syndrome. Clin Exp Ophthalmol. 2001;29(6):411–5.
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47. Madea B. Estimation of the time since death. 4th ed. Boca Raton: CRC Press; 2023.
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2. Madea B., editor. Handbook of Forensic Medicine. 2nd ed. Hoboken, NJ: Wiley; 2022.
3. Nikolić S, Živković V. Injuries and vital reactions patterns in hanging. Srp Arh Celok Lek. 2015;143(1–2):93–9.
4. Hellier C, Connolly R. Cause of death in judicial hanging: a review and case study. Med Sci Law. 2009;49(1):18–26.
5. Dettmeyer RB, Verhoff MA, Schütz HF. Forensic medicine: Fundamentals and perspectives. Heidelberg: Springer; 2014.
6. Nikolić S, Živković V. Cervical spine injuries in suicidal hanging without a long-drop-patterns and possible underlying mechanisms of injury: An autopsy study. Forensic Sci Med Pathol. 2014;10(2):193–7.
7. Taktak S, Kumral B, Unsal A, Ozdes T, Buyuk Y, Celik S. Suicidal hanging in Istanbul, Turkey: 1979–2012 Autopsy results. J Forensic Leg Med. 2015;33:44–9.
8. Värnik A, Kõlves K, van der Feltz-Cornelis CM, Marusic A, Oskarsson H, Palmer A, et al. Suicide methods in Europe: a gender-specific analysis of countries participating in the "European Alliance Against Depression". J Epidemiol Community Health. 2008;62(6):545-51.
9. Moftakhar L, Mirahmadizadeh A, Amiri S, Rezaei F, Azarbakhsh H. Epidemiology of Suicide by Hanging in Fars Province, Iran (2011-2019): A Population-based Cross-sectional Study. J Prev Med Public Health. 2023;56(3):264-71.
10. Morovatdar N, Moradi-Lakeh M, Malakouti SK, Nojomi M. Most common methods of suicide in Eastern Mediterranean Region of WHO: a systematic review and meta-analysis. Arch Suicide Res. 2013;17(4):335-44.
11. World Health Organization. Fact Sheets – Suicide [Internet]. United Nations: World Health Organization. 2023 [updated 2023; cited 2024 Jan 29]. Available from: https://www.who.int/news-room/fact-sheets/detail/suicide.
12. Madea B, Doberentz E, Jackowski C. Vital reactions - An updated overview. Forensic Sci Int. 2019;305:110029.
13. Spitz WU, Diaz FJ, editors. Spitz and Fisher’s Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation. 5th ed. Springfield, IL: Charles C Thomas; 2020.
14. DiMaio JV, Kimberley Molina D. DiMaio’s Forensic Pathology. 3rd ed. London New York: CRC Press; 2021.
15. Zátopková L, Janík M, Urbanová P, Mottlová J, Hejna P. Laryngohyoid fractures in suicidal hanging: A prospective autopsy study with an updated review and critical appraisal. Forensic Sci Int. 2018;290:70–84.
16. Maxeiner H, Bockholdt B. Homicidal and suicidal ligature strangulation—a comparison of the post-mortem findings. Forensic Sci Int. 2003;137(1):60–6.
17. Sharma BR, Harish D, Sharma A, Sharma S, Singh H. Injuries to neck structures in deaths due to constriction of neck, with a special reference to hanging. J Forensic Leg Med. 2008;15(5):298–305
18. Lockyer BE. Death by hanging: examination of autopsy findings and best approach to the post-mortem examination. Diagn Histopathol. 2019;25(11):423–30.
19. Madea, B, editor. Asphyxiation, Suffocation, and Neck Pressure Deaths. Boca Raton: CRC Press; 2020.
20. Payne-James J, Byard RW, editors. Forensic and Legal Medicine Clinical and Pathological Aspects. Boca Raton: CRC Press; 2023.
21. Marchetti D, Santoro L, Mercuri G. The “facie sympathique” sign in hanging: historical background, forensic review, and perspectives. Forensic Sci Med Pathol. 2023. https://doi.org/10.1007/s12024-023-00603-8.
22. Polson CJ, Gee DJ, Knight B, editors. The essentials of Forensic Medicine. Oxford: Pergamon Press; 1985.
23. Marchetti D, Boccardi L, Biondo D, Cittadini F. Oculo-sympathetic findings in cases of neck trauma. A systematic review. Rom J Leg Med. 2018;26(4):419-28.
24. Sauvageau A. Death by Hanging. In: Rutty, G, editor. Essentials of Autopsy Practice. London: Springer; 2014. p.23–38.
25. Clément R, Redpath M, Sauvageau A. Mechanism of death in hanging: a historical review of the evolution of pathophysiological hypotheses. J Forensic Sci. 2010;55(5):1268–71.
26. Yamasaki S, Kobayashi AK, Nishi K. Evaluation of suicide by hanging. Forensic Sci Med Pathol. 2007;3(1):45–51.
27. Risse M, Weiler G. Agonale und supravitale Bewegungsabläufe beim Erhängen. Beitr Gerichtl Med. 1989;47:243-6.
28. Sexual Asphyxia and Autoerotic Fatalities. In: Geberth VJ. Sex-Related Homicide and Death Investigation. 2nd ed. Boca Raton: CRC Press; 2010. p.175–224.
29. Berg S. Adrenalin- und Noradrenalinwerte im Blut bei gewaltsamen Todesursachen. Dtsch Z Gesamte Gerichtl Med. 1966;57(1–2):179–83.
30. Berg S, Bonte R. Catecholaminwerte im Leichenblut und -liquor bei verschiedenen Agonieformen. Zeitschrift für Rechtsmedizin. 2005;72(1):56–62.
31. Kauert G, Schoppek B, Eisenmenger W. Zur Frage der strangulationsbedingten kraniokaudalen Konzentrationsdifferenz biochemischer Parameter am Beispiel der Katecholamine. Ersticken. 1990;53–7.
32. Hirvonen J, Huttonen P, Lapinlampi T. Katecholamin-, Kortisol- und Histaminspiegel im Blut nach experimenteller Strangulation. Ersticken. 1990;58–63.
33. Wilke N, Janßen H, Fahrenhorst C, Hecker H, Manns MP, Brabant EG, et al. Postmortem determination of concentrations of stress hormones in various body fluids-is there a dependency between adrenaline/noradrenaline quotient, cause of death and agony time? Int J Legal Med. 2007;121(5):385–94.
34. Hoffmann JM, Elger CE, Kleefuss-Lie AA. The localizing value of hypersalivation and postictal coughing in temporal lobe epilepsy. Epilepsy Res. 2009;87(2-3):144-7.
35. Leibetseder A, Eisermann M, LaFrance WC, Nobili L, von Oertzen TJ. How to distinguish seizures from non‐epileptic manifestations. Epileptic Disorders. 2020;22(6):716–38.
36. Baumgartner C, Koren J, Britto-Arias M, Schmidt S, Pirker S. Epidemiology and pathophysiology of autonomic seizures: a systematic review. Clin Auton Res. 2019;29(2):137-50.
37. Suárez-Peñaranda JM, Cordeiro C, Rodríguez-Calvo M, Vieira DN, Muñoz-Barús JI. Cardiac inhibitory reflex as a cause/mechanism of death. J Forensic Sci. 2013;58(6):1644–7.
38. Doberentz E, Madea B. Traumatic carotid sinus reflex and postmortem investigation of the glomus caroticum in cases of pressure to the neck. In: Rutty, G, editor. Essentials of Autopsy Practice: Reviews, Updates and Advances. Switzerland AG: Springer Nature; 2020. p.67–88.
39. Arslan MN, Melez DO, Gülbeyaz H, Hosukler B, Sam B, Koç S. Possible death mechanisms other than respiratory asphyxia in a suicidal hanging case. Rom J Leg Med. 2013;21(3):169-72.
40. Criminocorpus. Archives de l’anthropologie criminelle (tome 14 ; 1899) — Page 178 | [Internet]. France: Musée Criminocorpus [cited 2024 Jan 29]. Available from: https://criminocorpus.org/fr/bibliotheque/page/9565/
41. Mtui E, Gruener G, Dockery P, FitzGerald MJT. Fitzgerald’s clinical neuroanatomy and neuroscience. 7th ed (International Edition). Philadelphia, PA: Elsevier; 2015.
42. Minovici N. Études sur la pendaison (1905). Paris, France: Hachette Livre Bnf. 2020;
43. Đurić M, editor. Anatomija glave i vrata. Belgrade, Serbia: University of Belgrade – Faculty of Medicine, CIBID; 2020.
44. Flaherty PM, Flynn JM. Horner Syndrome Due to Carotid Dissection. J Emerg Med. 2011;41(1):43–6.
45. Chan CCK, Paine M, O’Day J. Carotid dissection: a common cause of Horner’s syndrome. Clin Exp Ophthalmol. 2001;29(6):411–5.
46. Mahan MA. Nerve stretching: a history of tension. J Neurosurg. 2019;132(1):252–9.
47. Madea B. Estimation of the time since death. 4th ed. Boca Raton: CRC Press; 2023.
48. Asirdizer M, Kartal E. Neck vascular lesions in hanging cases: A literature review. J Forensic Leg Med. 2022;85:102284.
Published
2026/06/16
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