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Three Nonlethal Ligature Strangulations Filmed by an Autoerotic Practitioner: Comparison of Early Agonal Responses in Strangulation by Ligature, Hanging, and Manual Strangulation

Sauvageau, Anny MD, MSc*; Ambrosi, Corinne MD; Kelly, Sean MD

The American Journal of Forensic Medicine and Pathology: December 2012 - Volume 33 - Issue 4 - p 339–340
doi: 10.1097/PAF.0b013e3182663002
Case Reports

Despite great advances in forensic sciences in the last decades, our knowledge of the pathophysiology of ligature strangulation is still largely based on old writings from the 19th and beginning of the 20th century. The study of filmed hangings by the Working Group on Human Asphyxia has contributed to a better understanding of the agonal responses to strangulation by hanging, and judo-related studies have given some insight into the pathophysiology of manual strangulation, but the pathophysiology of ligature strangulation has remained largely unexplored so far. Three nonlethal strangulations filmed by an autoerotic practitioner are here presented. In these 3 ligature strangulations, the 35-year-old man is sitting on a chair. A pair of pajama pants is rolled once around his neck, with the extremities of the pants falling down on each side of his chest. The man is pulling the extremities of the pants with both hands to apply compression on his neck. After losing consciousness, he ceases to pull on the ligature, and the pants slowly loosen around the neck. A few seconds later, he regains consciousness and gets up from the chair. In the 3 nonlethal ligature strangulations presented in this study, the loss of consciousness occurred in 11 seconds. The loss of consciousness was closely followed by the onset of convulsions (7–11 seconds). These results are compared with the early agonal responses documented in filmed hangings and judo studies.

From the *Office of the Chief Medical Examiner, Edmonton, Alberta, Canada; and †Office of the Chief Medical Examiner, Jamaica, NY.

Manuscript received August 4, 2010; accepted August 23, 2010.

This work was supported by the other members of the Working Group on Human Asphyxia: Dr Romano LaHarpe from Switzerland, Mr Vernon J. Geberth from United States, and from Canada, Dr David E. L. King, Dr Graeme Dowling, and Dr Sam Andrews.

The authors report no conflict of interest.

Reprints: Anny Sauvageau, MD, MSc, Office of the Chief Medical Examiner, 7007, 116 St, Edmonton, Alberta, Canada T6H 5R8. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.