Upside-down death - the pathophysiology of inversion

Abstract

Historically, deaths occurring in a head-down position were generally associated with inverted suspension inflicted upon the victim as a form of torture. In the current day, deaths occurring due to an inverted body position are rare and are usually the result of freak accidents which often attract media attention due to the unusual nature of the death. Occasionally an element of inverted suspension is present in deaths occurring in motor vehicle incidents when the vehicle rolls, coming to rest on its roof with the unconscious victim left suspended upside-down by the seat belt. Human physiology has evolved to work in combination with gravity and the effects of hanging upside down for prolonged periods are poorly understood. I will review deaths associated with the head-down position and the underlying pathophysiology of inversion leading to death.