A Cross Sectional Study About Presence of Sternocleidomastoid Muscle Haemorrhage and Thoracolumbar Vertebral Disc Haemorhage as a Sign of Antemortem Hanging

Suicide by hanging is a prevalent method of death in India, yet distinguishing between antemortem and postmortem hanging remains a significant forensic challenge. This study evaluates the diagnostic value of two internal vital signs: hemorrhage at the origin of the sternocleidomastoid (SCM) muscle and thoracolumbar intervertebral disc hemorrhage (Simon’s sign). The objective was to estimate the frequency of these hemorrhages and assess their reliability as ancillary signs of antemortem hanging. A prospective cross-sectional study was conducted over 18 months in which 200 cases of death by hanging were studied in tertiary care centre. Of the 200 cases analyzed, 96% involved complete suspension. The majority of victims were male (64.5%), with the highest prevalence in the 21–30 year age group. Sternocleidomastoid muscle hemorrhage was observed in 28.5% of cases, exclusively at the clavicular origin. Intervertebral disc hemorrhage was present in 26% of cases, predominantly in the lumbar region. A significant correlation was found between complete suspension and the presence of these hemorrhages; neither sign was observed in cases of incomplete suspension. Furthermore, the frequency of disc hemorrhage decreased with advancing age, likely due to degenerative spinal changes. Both signs occurred simultaneously in only 9.5% of cases. Hemorrhages in the SCM muscle and intervertebral discs serve as useful ancillary signs of antemortem hanging, particularly in cases of complete suspension. However, they are not sensitive or specific enough to be used as solitary diagnostic criteria.