the damage potential of strangulation goes beyond hypoxic injury. the hyoid bone is just under your chin, and it's about as fragile as a wishbone. even pressure that isn't enough to cut off someone's airway can break the hyoid bone, which is a life threatening injury.
strangulation can also cause carotid artery dissection, where the inner lining of the artery tears lengthways, allowing blood to pool in a kind of pseudoaneurysm, which is the most common cause of massive stroke in people under 50, as the dissection throws clots in a direct path to the brain.
a blood choke can throw a clot even without dissecting the carotid, if bloodflow is partially obstructed long enough for a clot to form and enter the brain once pressure is released.
these injuries are not dramatic in the moment. most people who lose consciousness due to hypoxia do not even recall doing so- they are not even aware they were ever unconscious at all. it occurs in under ten seconds if blood flow is obstructed. the person will often experience something called an anoxic seizure, which can make it appear as if they are still conscious, as they will still be moving, rather than limp and unresponsive, and anoxic seizures during sexual activity have been mistaken for orgasm by the strangling party. even in brief unconsciousness of less than a minute, undetectable to either party, the hypoxic insult to the brain is serious, and causes permanent damage. this damage is cumulative too, and worsens with repeated insults.
symptoms of a dissection, stroke, hypoxic injury or hyoid bone fracture may not present themselves immediately, either. it can be hours, days, even months later if it's a dissection. the thyroid can also be injured, and lead to permanent thyroid difficulties. the trachea and larynx can be damaged- some people have lost the ability to speak.
the structures in the neck are some of the most delicate in the human body. any amount of strangulation is regarded as a likely medical emergency in medicine. i was kept under observation for two days after a case of accidental ligature strangulation when i got my neck caught in a curtain cord as a child. and i didn't even have bruises or lose the ability to breathe. there is no safe amount of strangulation. even if you can still breathe, it can still kill you, or cause permanent damage.
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