· Pressure on the neck may arise from manual strangulation, ligature strangulation, hanging, direct blows, arm-locks and a variety of accidental lesions, such as entanglement with cords or falling onto the neck.
· The occlusion of carotid arteries is less common as the higher internal pressure of the carotid arteries resists occlusion and also they are situated much more deeply.
· The carotids are largely obscured by the sternomastoid muscles.
· If bilateral occlusion of the carotids occurs, almost immediate unconsciousness will ensue, as the supply of arterial blood to the brain by the vertebral circulation is insufficient to maintain cortical function, which depends mainly upon the anterior and middle cerebral arteries that arise from the carotid supply.
· Occlusion of the vertebral arteries by neck compression seems virtually impossible
· Vagal reflex has profound implications in relation to pressure or blows on the neck. Sometimes called ‘vagal inhibition’, ‘vasovagal shock’ or ‘reflex cardiac arrest’, the rapid onset of heart stoppage may antedate any evidence of congestive or ‘asphyxial’ signs, causing death immediately or within seconds, or at any time thereafter.
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