A woman is seized from behind in an alley and collapses almost immediately after her assailant locks a forearm across her neck. She dies shortly afterwards. Which mechanism best explains the near-instantaneous loss of consciousness?
- A Bilateral compression of the carotid arteries and carotid sinuses causing acute cerebral ischaemia and bradycardia ✓
- B Complete mechanical occlusion of the trachea
- C Fracture of the hyoid bone with retropharyngeal haematoma
- D Occlusion of both vertebral arteries by muscular spasm
Correct answer: A. Bilateral compression of the carotid arteries and carotid sinuses causing acute cerebral ischaemia and bradycardia
Explanation
This is mugging or the choke hold, where the forearm presses the carotid triangles bilaterally. Occluding the carotid arteries cuts cerebral blood flow, and pressure on the carotid sinuses triggers reflex bradycardia and hypotension, producing unconsciousness within seconds, often before any significant airway obstruction develops. Hyoid fracture is uncommon in this technique and would take minutes to cause symptoms, while isolated vertebral artery occlusion cannot explain such rapid collapse.
Reference: Modi's Medical Jurisprudence and Toxicology, 23rd ed.
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Written and medically reviewed by the StethoPrep medical team.