“…In a National Family Justice Center study in which 300 victims reported a strangulation assault, only three victims sought any medical help at the time of the assault. According to chapters regarding medical evidence written by Dr. William Green and Forensic Pathologist Dean Hawley in the CDAA’s (California District Attorneys Association), manual for “The Investigation and Prosecution of Strangulation Cases”, without a continuous supply of oxygen brain cells quickly malfunction and die. Some die immediately, others can take weeks, causing the delayed death of the assault victim.
Even minimal force may cause bleeding and/or swelling inside the neck. The great risk is that both bleeding and swelling can progress (often slowly) and not cause obvious problems until the airway is blocked or a vascular disaster occurs.Anywhere from 5.5 to 22 pounds of pressure can damage the carotid arteries which compromises blood flow to the brain. Delayed findings may include bleeding and damage to the inside of the artery.
As the body tries to heal, blood clots may form inside the artery and block blood flow or break off and travel to the brain, resulting in clinical findings similar to those of a stroke. Only 4.4 pounds of pressure on the jugular veins may cause a back up of oxygen-deficient blood in the brain, resulting in the rupture of internal blood vessels and lack of oxygen to the brain.
Compression of the carotid body, a neurologic structure located in the back of the neck, can result in the slowing of the pulse and progress to cardiac arrest. Strangulation may cause fluid overload in the lungs, (pulmonary edema), up to two weeks after the assault. During the assault, vomit may end up in the victims lungs. The digestive fluids in the vomit may begin to “digest” the victim’s lungs causing pneumonitis.
Other neurologic signs and symptoms may include vision changes, ringing in the ears, facial or eyelids drooping, one-sided weakness, incontinence and miscarriage. Weeks to months after an assault, a victim may have problems sleeping, and experience impairment in memory and concentration.
Mental health problems can include anxiety, depression and dementia. In up to 50 percent of cases, there are no visible bruises.
“Victims really do underestimate the danger of the situation,” said Randi Breager, Domestic Violence/Assault Coordinator for the Alaska State Troopers. Breager gives 20 to 30 domestic violence trainings per year for troopers and police throughout Alaska….”