Judicial hanging: postmortem radiographic, CT, and MR imaging features with autopsy confirmation.

Abstract

To assess postmortem radiologic and pathologic findings by using modern imaging and autopsy techniques in two recent cases of judicial hangings. Cervical spine radiography; computed tomography (CT) of the head, neck, and chest; magnetic resonance (MR) imaging of the head and cervical spine; and vertebral angiography were followed by a complete autopsy, including head and neck dissection. The first case (subaural knot) showed cervical spine ligamentous injury and partial disruption of the vertebral arteries without vertebral subluxation or injury to the cervical cord. The second case (submental knot) showed complete ligamentous disruption and subluxation at C2-3 with complete cord transection. In both cases, minimally displaced transverse process fractures were present, and CT and MR imaging of the head showed diffuse subarachnoid hemorrhage. The extent and distribution of injuries differed markedly in the two cases. The first case involved loss of consciousness probably from subarachnoid hemorrhage or cerebral hypoxia, followed by death due to cerebral anoxia. The second case involved a major spinal cord injury with subarachnoid hemorrhage.