title: Cervical arterial injury after strangulation--different types of arterial lesions.
abstract: After strangulation, cervical arterial injuries (CAI) are uncommon. We report three unusual cases where strangulation induced immediate stroke. CAI were examined using brain CT scan and Doppler ultrasonography in the three cases and then by autopsy in one of the victims. One of the two victims who survived the attempted strangulation had a unilateral carotid dissection, whereas in the other victim, no arterial dissection or thrombosis was observed. As regards the deceased victim, the autopsy confirmed the bilateral dissection showed on CT scan and Doppler ultrasonic examination and revealed that both carotid arteries were dilated up to two times the normal diameter. Microscopic examination showed a major bilateral hemorrhagic dissection of the media with obliterating fibrous endarteritis lesions associated with inflammatory damage. CT scan with arteriography does not demonstrate all the different types of arterial injury, particularly atheromatous embolism, direct compression, or prolonged spasm. Thus, traditional autopsy remains an essential forensic tool after strangulation to show the type of CAI.
authors.affiliation: Department of Forensic Medicine, Rouen University Hospital-Charles Nicolle, 1 rue de Germont, 76031, Rouen Cedex, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Le Blanc-Louvry
authors.forename: Fréderique
authors.initials: F
authors.lastname: Papin
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Vaz
authors.forename: Bernard
authors.initials: B
authors.lastname: Proust
mesh_terms: D000328:Adult; D000368:Aged; D001237:Asphyxia / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology*; D002341:Carotid Artery Thrombosis / Q000000981:diagnostic imaging; D020215:Carotid Artery, Internal, Dissection / Q000209:etiology / Q000473:pathology*; D019548:Crime Victims; D004108:Dilatation, Pathologic; D005260:Female; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D008297:Male; D019838:Neck Injuries / Q000473:pathology*; D020521:Stroke / Q000209:etiology; D014057:Tomography, X-Ray Computed; D017540:Tunica Media / Q000293:injuries / Q000473:pathology; D018608:Ultrasonography, Doppler
keywords: autopsy; carotid artery disease; central stroke; forensic pathology; forensic science; strangulation; thrombosis