Acute alcohol intoxication and lethal neck flexion

Positional asphyxia occurs when the mechanics of normal respiratory processes are impaired by the position of the body, not by external crushing forces. It is a well-known complication of drug and alcohol intoxication. However, less well appreciated is the potential role of neck hyperflexion as a specific cause of death in individuals with acute alcohol intoxication. Two cases are reported to demonstrate the usefulness of meticulous scene descriptions and documentation in cases of alcohol toxicity. Case 1: An intoxicated 51-year-old woman was found deceased with neck hyperflexion due to pressure on her head from a vehicle bumper bar (blood alcohol 0.24%). Case 2: An intoxicated 46-year-old man was found lying on his back with his neck acutely flexed and his chin pressed firmly into his shoulder (blood alcohol 0.4%). In both cases the deaths were attributed to positional asphyxia due to hyperflexion of the neck associated with alcohol intoxication, with potential exacerbation from concussion and alcohol/drug effects. Careful review of the scene findings and statements from those who are first to find a body in cases of acute alcohol intoxication may be necessary to determine the incidence of marked neck hyperflexion and its possible role in these deaths.