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Strangulation is squeezing of the neck with enough force to block the flow of blood to the brain and/or the flow air to the lungs. The loss of blood flow deprives the brain cells of vital oxygen. Even short periods of time without oxygen can cause damage to the brain.
The Brain
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Strangulation may be caused by someone’s hands or arm, or an item wrapped around the neck. It may be the result of:
  • An act of violence
  • An accident, especially home hazards in young children
  • Participation in activities with intentional strangulation
  • Suicide attempt

Risk Factors

Risk factors depend on the cause of the strangulation.


Symptoms will depend on the force that is applied and the length of time it is applied. Some symptoms will be immediate while others may take a few hours or days to appear.
The interference with blood flow can cause:
  • Confusion
  • Mental changes such as memory problems, depression, insomnia, and anxiety
  • Lightheadedness
  • Loss of consciousness
  • Weakness or numbness
  • Death
Damage to the structures of the neck such as hyoid bone, voice box, or windpipe can cause:
  • Difficulty breathing
  • Difficulty swallowing
  • Difficulty speaking
  • Pain
Some visible damage may include:
  • Redness
  • Bruising
  • Scrapes
  • Swelling
  • Broken blood vessels in the eyes or on the skin
Repeated strangulation can increase the risk of long-term damage and death.


The diagnosis is made based on information provided by the patient or a witness, and a physical exam.
Blood tests and x-rays may be done to look for any damage


Treatment will be based on the severity of injury.
  • Soft tissue injuries can be managed with ice and rest.
  • Soft foods or a liquid diet may be recommended if swallowing is too painful or difficult.
  • Over the counter pain relievers may be advised to help reduce discomfort and swelling.
More severe injuries may require medical or surgical support to:
  • Support breathing until the throat heals
  • Treat pain
  • Address mental changes due to brain damage
  • Repair any injuries
  • Learn new swallowing techniques
Referral for counselling may be needed


To help reduce your chance of strangulation:
  • Seek help if you are in an abusive relationship.
  • Avoid harmful behaviors that may block blood flow to the brain or air flow to the lungs. Even minor interruption in blood flow can cause damage to the brain.
  • Call for immediate help if you are thinking about suicide.
  • Seek help if you are depressed.
  • Childproof your home.


Centers for Disease Control and Prevention
Kid's Health—Nemours Foundation


Health Canada


Choking game prevention, children ages 6-19 years. Centers for Disease Control and Prevention website. Available at: Updated June 2010. Accessed December 15, 2017.
Household safety. Nemours Kid's Health website. Available at: Updated October 2016. Accessed December 15, 2017..
Strangulation injury—emergency management. EBSCO DynaMed Plus website. Available at: . Accessed December 15, 2017.
Strangulation Can Leave Long-Lasting Injuries. Domestic Shelters website. Available at: Updated April 4, 2016. Accessed December 15, 2017.

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