Three Different Mechanisms of Death: An Unusual Form of a Child Murder by AsphyxiaMiziara, Ivan Dieb MD, PhD; Bertaccini, Flavio MDAmerican Journal of Forensic Medicine & Pathology: June 2011 - Volume 32 - Issue 2 - pp 164-165 doi: 10.1097/PAF.0b013e318219c832 Case Reports Abstract Author Information We report a very unusual case of murder of a 4-year-old male white child who died of asphyxiation. Asphyxia occurred due to 3 factors: manual strangulation, hyperextension of the neck, and atlantoaxial subluxation. The offenses were carried out by a single assailant (the stepfather of the child) who strangled the child with his right hand, using his left hand to pull the hair of the child, forcing the head back and causing hyperextension of the neck, thereby dislocating the first and second cervical vertebrae. From the Hospital das Clínicas-São Paulo University School of Medicine; and Legal Medicine Institute, São Paulo, Brazil. Manuscript received April 28, 2008; accepted November 13, 2008. Reprints: Ivan Dieb Miziara, MD, PhD, Hospital das Clínicas-São Paulo University School of Medicine, Teodoro Sampaio, 352-22, São Paulo, Brazil 05406000l. E-mail: email@example.com. © 2011 Lippincott Williams & Wilkins, Inc.