Simon’s bleedings: a possible mechanism of appearance and forensic importance—a prospective autopsy study

  • Slobodan NikolićEmail author
  • Vladimir Živković
  • Fehim Juković
  • Dragan Babić
  • Goran Stanojkovski
Original Article


Simon’s bleedings are stripe-like hemorrhages on the ventral surface of the intervertebral disks of the lumbar part of the spinal column. The aims of this study were to determine the appearance frequency of Simon’s bleedings in cases of hanging and in other cases of asphyxiations and to determine if the age of the deceased was in correlation with the occurrence of Simon’s bleedings. A prospective autopsic study included 147 cases of hanging, 39 other asphyxiation deaths, and 461 deaths other than asphyxiation (blunt trauma, natural deaths, etc.). Simon’s bleedings were present in 62.8% cases of hanging and in 61.5% cases of other types of asphyxiations. Simon’s bleedings are not specific for hanging (χ 2 = 0.022, p > 0.05). Simon’s bleedings were less frequent in other cases. It was established that the older the person was, the possibility of Simon’s bleedings to occur would be less (Spearman’s correlation coefficient = −0.225, p < 0.001; Wald coefficient = 29.798, p < 0.001). In the cases of hanging, there is statistically significant difference in average age between the groups with and without Simon’s bleedings (t = 2.875, p = 0.017). The older the person was, the lower the likelihood of Simon’s bleedings to occur: if the person was more than 60 years old, there was 70% probability of not having Simon’s bleedings, and if older than 70, this probability would rise to 88% (Wald coefficient = 7.609, p = 0.021). In older persons who died due to hanging, throat skeleton fractures accompanied by local hemorrhage could be considered as a vital sign. In younger persons, where throat skeleton fractures are less frequent, Simon’s bleedings could be the vital sign of premortem hanging. Simon’s bleedings, in cases of asphyxiation, most likely occur due to agonal convulsions and forced movements in lumbosacral part of spinal column. Additional factor for the appearance of Simon’s bleedings in hanging is traction of body and especially this part of spinal column due to gravity.


Simons’ bleeding Hanging Vital sign Forensic pathology 



We thank the Ministry of Science and Technological Development of Republic of Serbia for supporting this study.


  1. 1.
    Saukko P, Knight B (2004) Knights forensic pathology, 3rd edn. Arnold, LondonGoogle Scholar
  2. 2.
    Di Maio VJ, Di Maio D (2001) Forensic pathology, 2nd edn. CRC, Boca RatonGoogle Scholar
  3. 3.
    Vanezis P (1989) Pathology of neck injury. Butterworths, LondonGoogle Scholar
  4. 4.
    Betz P, Eisenmenger W (1996) Frequency of throat–skeleton fractures in hanging. Am J Forensic Med Pathol 17(3):191–193PubMedCrossRefGoogle Scholar
  5. 5.
    Feigin G (1999) Frequency of neck organ fractures in hanging. Am J Forensic Med Pathol 20:128–130PubMedCrossRefGoogle Scholar
  6. 6.
    Uzun I, Buyuk Y, Gurpinar K (2007) Suicidal hanging: fatalities in Istanbul: retrospective analysis of 761 autopsy cases. J Forensic Leg Med 14(7):406–409PubMedCrossRefGoogle Scholar
  7. 7.
    Suarez-Penaranda JM, Alvarez T, Miguens X et al (2008) Characterization of lesions in hanging deaths. J Forensic Sci 53(3):720–723PubMedCrossRefGoogle Scholar
  8. 8.
    Azmak D (2006) Asphyxial deaths: a retrospective study and review of the literature. Am J Forensic Med Pathol 27(2):134–144PubMedCrossRefGoogle Scholar
  9. 9.
    Nikolic S, Micic J, Atanasijevic T et al (2003) Analysis of neck injuries in hanging. Am J Forensic Med Pathol 24(2):179–182PubMedCrossRefGoogle Scholar
  10. 10.
    Simonsen J (1988) Patho-anatomic findings in neck structures in asphyxiation due to hanging: a survey of 80 cases. Forensic Sci Int 38:83–91PubMedCrossRefGoogle Scholar
  11. 11.
    Morild I (1996) Fractures of neck structures in suicidal hanging. Med Sci Law 36:80–84PubMedGoogle Scholar
  12. 12.
    Paparo GP, Siegel H (1984) Neck markings and fractures in suicidal hangings. Forensic Sci Int 24(1):27–35PubMedCrossRefGoogle Scholar
  13. 13.
    Senol E, Demirel B, Akar T et al (2008) The analysis of hormones and enzymes extracted from endocrine glands of the neck region in deaths due to hanging. Am J Forensic Med Pathol 29(1):49–54CrossRefPubMedGoogle Scholar
  14. 14.
    Zhu BL, Ishida K, Fujita MQ, Maeda H (2000) Immunohistochemical investigation of pulmonary surfactant in fatal mechanical asphyxia. Int J Legal Med 113:268–271PubMedCrossRefGoogle Scholar
  15. 15.
    Wilke N, Jansen H, Fahrenhorst C et al (2007) Post-mortem determination of concentrations of stress hormones in various body fluids—is there a dependency between adrenaline/noradrenaline quotient, cause of death and agony time? Int J Legal Med 121:385–394PubMedCrossRefGoogle Scholar
  16. 16.
    Yen K, Vock P, Christe A et al (2007) Clinical forensic radiology in strangulation victims: forensic expertise based on magnetic resonance imaging (MRI) findings. Int J Legal Med 121:115–123PubMedCrossRefGoogle Scholar
  17. 17.
    Aghayev E, Yen K, Sonnenschein M et al (2005) Pneumomediastinum and soft tissue emphysema of the neck in post-mortem CT and MRI; a new vital sign in hanging. Forensic Sci Int 153:181–188PubMedCrossRefGoogle Scholar
  18. 18.
    Puschel K, Turk E, Lach H (2004) Asphyxia–related deaths. Forensic Sci Int 144:211–214PubMedCrossRefGoogle Scholar
  19. 19.
    Brinkmann B, Madea B (2004) Handbuch gerichtliche Medizin. Springer, BerlinGoogle Scholar
  20. 20.
    Saternus KS, Dotzauer G, Imhauser G (1979) The importance of Simon’s symptom in cases of hanging. Z Rechtsmed 83(4):283–289PubMedCrossRefGoogle Scholar
  21. 21.
    Lignitz E, Henn V (2007) New autopsy signs in violent death. Forensic Sci Int 165:172–177PubMedCrossRefGoogle Scholar
  22. 22.
    Ogata M, Kazutoshi A, Ihoko A et al (2007) A fatal case of hypothermia with hemorrhages of the pectoralis minor, intercostal, and iliopsoas muscles. Am J Forensic Med Pathol 28(4):348–352PubMedCrossRefGoogle Scholar
  23. 23.
    Guan Y, Yoganandan N, Moore J et al (2007) Moment–rotation responses of the human lumbosacral spinal column. J Biomech 40(9):1975–1980PubMedCrossRefGoogle Scholar
  24. 24.
    Pintar FA, Yoganandan N, Myers T et al (1992) Biomechanical properties of human lumbar spine ligaments. J Biomech 25(11):1351–1356PubMedCrossRefGoogle Scholar
  25. 25.
    Sauvageau A, Racette S (2007) Agonal sequences in a filmed suicidal hanging: analysis of respiratory and movement responses to asphyxia by hanging. J Forensic Sci 52(4):957–959PubMedCrossRefGoogle Scholar
  26. 26.
    Gilbert JD, Jensen L, Byard RW (2008) Further observation on the speed of death in hanging. J Forensic Sci 53:1204–1205PubMedCrossRefGoogle Scholar
  27. 27.
    Padoch SA, Schmidt PH, Kroner LU, Madea B (2005) Death due to positional asphyxia under severe alcoholisation: pathophysiologic and forensic consideration. Forensic Sci Int 149:67–73CrossRefGoogle Scholar
  28. 28.
    Iscan MY (1989) Age markers in the human skeleton. Charles Thomas, Springfield, ILGoogle Scholar
  29. 29.
    Garvin HM (2008) Ossification of laryngeal structures as indicators of age. J Forensic Sci 53(5):1023–1027PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Slobodan Nikolić
    • 1
    Email author
  • Vladimir Živković
    • 1
  • Fehim Juković
    • 2
  • Dragan Babić
    • 3
  • Goran Stanojkovski
    • 4
  1. 1.The Institute of Forensic Medicine, School of MedicineUniversity of BelgradeBelgradeSerbia
  2. 2.The County Hospital of the City of Novi PazarNovi PazarSerbia
  3. 3.Institute of Medical Statistics and Informatics, School of MedicineUniversity of BelgradeBelgradeSerbia
  4. 4.Department of Pathology and Forensic MedicineClinical Centre of the City of East Sarajevo in KasindolKasindolBosnia and Herzegovina

Personalised recommendations