Strangling

Strangling is compression of the neck that may lead to unconsciousness or death by causing an increasingly hypoxic state in the brain. Fatal strangling typically occurs in cases of violence, accidents, and is one of two main ways that hanging causes death (alongside breaking the victim's neck). Strangling does not have to be fatal; limited or interrupted strangling is practised in erotic asphyxia, in the choking game, and is an important technique in many combat sports and self-defense systems. Strangling can be divided into three general types according to the mechanism used: Hanging — Suspension from a cord wound around the neck Ligature strangulation — Strangulation without suspension using some form of cord-like object called a garrote Manual strangulation — Strangulation using the fingers or other extremity Strangling involves one or several mechanisms that interfere with the normal flow of oxygen into the brain: Compression of the carotid arteries or jugular veins—causing cerebral ischemia. Compression of the laryngopharynx, larynx, or trachea—causing asphyxia. Stimulation of the carotid sinus reflex—causing bradycardia, hypotension, or both. Depending on the particular method of strangulation, one or several of these typically occur in combination; vascular obstruction is usually the main mechanism. Complete obstruction of blood flow to the brain is associated with irreversible neurological damage and death, but during strangulation there is still unimpeded blood flow in the vertebral arteries. Estimates have been made that significant occlusion of the carotid arteries and jugular veins occurs with a pressure of around , while the trachea demands six times more at approximately . As in all cases of strangulation, the rapidity of death can be affected by the susceptibility to carotid sinus stimulation. Carotid sinus reflex death is sometimes considered a mechanism of death in cases of strangulation, but it remains highly disputed.