Simon's bleedings: a possible mechanism of appearance and forensic importance--a prospective autopsy study

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 (chi (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.