Which of the following is the primary mechanism of death in typical suicidal hanging?

Explanation

## Mechanism of Death in Hanging **Key Point:** In typical suicidal hanging (drop < 2 metres), death occurs primarily from cerebral anoxia due to compression of the carotid arteries, NOT from tracheal compression or spinal cord injury. ### Pathophysiology of Hanging Death ```mermaid flowchart TD A[Ligature applied to neck]:::outcome --> B{Type of hanging?}:::decision B -->|Judicial/High drop| C[Spinal cord transection]:::urgent B -->|Typical suicidal/Low drop| D[Carotid artery compression]:::action D --> E[Cerebral blood flow obstruction]:::action E --> F[Cerebral anoxia]:::outcome E --> G[Loss of consciousness in 10-15 sec]:::outcome G --> H[Death in 3-5 minutes]:::outcome ``` ### Mechanisms by Hanging Type | Mechanism | Judicial Hanging | Suicidal Hanging | Manual Strangulation | |-----------|------------------|------------------|----------------------| | **Primary cause of death** | Spinal cord transection | Carotid compression | Tracheal compression | | **Drop distance** | > 2 metres (calculated) | < 2 metres | N/A | | **Time to death** | Seconds (if drop calculated) | 3–5 minutes | 5–15 minutes | | **Mechanism** | Sudden jerking force | Gradual pressure | Gradual pressure | **High-Yield:** The carotid arteries are compressed at a pressure of only 2–3 kg, whereas the trachea requires 15–20 kg of pressure to occlude. This is why carotid compression is the primary mechanism in typical hanging. **Mnemonic:** **CAT** — **C**arotid compression in typical hanging; **A**sphyxia (tracheal) in manual strangulation; **T**ransection in judicial hanging. **Clinical Pearl:** Loss of consciousness occurs within 10–15 seconds of carotid compression due to cessation of cerebral blood flow, even though the airway may not be completely obstructed.