How a tear becomes a stroke
A tear in the lining of an artery is called a dissection. Blood can collect in the wall and narrow the artery, or a clot can form at the tear and travel into the brain. The American Heart Association describes dissection of the arteries in the neck as an important cause of stroke in young adults, from all causes, not only strangulation. After strangulation, the Institute for Addressing Strangulation warns that strokes can happen days, weeks or even months later.
No marks doesn’t mean no injury
The tear is inside the neck, so a person can have one and no mark at all, and feel fine at first. Doctors have published reports of carotid artery dissections after strangulation in which the symptoms appeared only after a delay. A 2022 report of 10 cases involving chokeholds used in combat sports, which press on the sides of the neck, described 5 carotid artery dissections, 3 vertebral artery dissections and 2 strokes without a dissection.
How often scans find an injury
Most people who are scanned after strangulation do not have an artery injury, but some do. Of 142 patients who had a CT scan of the neck arteries after strangulation, 6 were first reported to have a blood-vessel injury, and 3 after a second review. Among 345 women strangled by partners, 2 had a dissection of the internal carotid artery and 2 had strokes. The Training Institute on Strangulation Prevention states that there are no reliable signs that predict who has a blood-vessel injury and who does not.
What doctors are told to do
UK guidelines tell emergency departments to do a CT angiogram, a CT scan of the blood vessels in the neck and head, within an hour for people with warning signs after strangulation, and say ultrasound and plain X-rays are not recommended. They say people can remain at risk of artery problems for up to 12 months, and that watching someone without a scan does not rule out a blood-vessel injury. Separate UK guidance for children under 16 does not recommend this scan in children.
What it means
Get checked after pressure on your neck, even if you feel fine and have no marks, and say “I was strangled” so staff know to look for these injuries. If symptoms start or get worse later, go back. Signs of a stroke include a drooping face, a weak or numb arm and slurred speech. If any of these appear, at any point, call 911. What to expect at the ER →
Sources
- Yaghi et al., American Heart Association scientific statement, Stroke 55(3) (2024).
- Institute for Addressing Strangulation, There Is No Safe Way to Strangle: position statement (2024, reviewed 2025).
- Clarot et al., Forensic Science International 149 (2005).
- Stellpflug et al., Journal of Emergency Medicine (2022).
- Zuberi et al., Emergency Radiology 26(5) (2019).
- Bergin et al., Journal of Head Trauma Rehabilitation 37(1) (2022).
- Training Institute on Strangulation Prevention, letter to medical providers; Smock, Green & Sturgeon, medical recommendations (rev. 2022).
- Institute for Addressing Strangulation, Guidelines for clinical management of non-fatal strangulation in acute and emergency care services (2025); pediatric guidelines (2026).