# Suicide by ligature strangulation and/or hanging inside a motor vehicle: a comprehensive review

## TL;DR

This paper reviews rare cases of suicide by ligature strangulation or hanging inside vehicles, highlighting challenges in determining the exact cause of death.

## Contribution

The study provides a comprehensive forensic analysis of vehicle-assisted strangulation/hanging cases, emphasizing diagnostic challenges.

## Key findings

- Most cases involved young or adult males, with a few psychiatric histories and toxicological findings.
- Hard ligature materials were commonly used, but internal signs of asphyxia were not always present.
- Classification of deaths as strangulation or hanging was sometimes ambiguous, requiring detailed forensic analysis.

## Abstract

Suicide by ligature strangulation/hanging inside vehicles is uncommon, and only few cases have been reported in the literature. This study aimed to conduct a comprehensive review of reported cases of suicide by ligature strangulation/hanging inside vehicles, analyzing the features of the death scene, of the ligature and furrow, autopsy findings, and causes of death. The comprehensive review was performed following the PRISMA guidelines by using the most common scientific databases. According to inclusion criteria, a total of 20 cases of vehicle-assisted strangulation/hanging were reviewed: 13 cases were assessed as ligature strangulation resulting in 7 complete decapitations and 7 other cases as hanging. All victims were young or adult males, except for one 48-year-old female. Death was assessed as suicide in all cases, except for a possible accidental autoerotic death. In 8 cases, a history of depression or other psychiatric disorders was reported. Toxicological analysis were positive in 7 cases. Hard ligature materials (nylon, steel, plastic, hemp ropes) were used in most cases, but only 13 cases had a well-demarcated furrow. In 2 cases, no internal findings of asphyxia were found. An additional case of ligature strangulation inside a motor vehicle off is also presented, where no autopsy findings of asphyxia were observed, except for a broad pale furrow and monolateral conjunctival petechiae. This study highlights the challenges in classifying suicidal hanging and ligature strangulation in motor vehicles.

1. Suicide by ligature strangulation or hanging inside motor vehicles is uncommon, with few cases documented inthe literature.

2. Determining the type of asphyxia death (ligature strangulation or hanging) for victims who died due tocompression to the neck by a ligature can be challenging.

3. Sometimes the specific subtype cannot be determined, the case should be classified as "strangulation nototherwise specified".

4. Different elements (type of ligature materials used, the presence of well-demarcated furrows, and internal signsof asphyxia) could complicate the determination of the cause of death.

5. Forensic pathologists must analyze every aspect, in order to conduct an accurate analysis.