Asphyxial deaths and petechiae: A review

Conjunctival and facial petechiae, although nonspecific findings, are consi dered hallmarks of asphyxial deaths. Consensus in the literature suggests t hat their pathogenesis is related to the combined effects of increased ceph alic venous pressure and hypoxic damage to endothelial cells. Despite the c ommon knowledge that they are neither predictable findings in all asphyxial deaths nor rare in natural, nonaphyxial deaths, the belief persists that p etechiae are corroborative evidence of asphyxia. We suggest that a clear, p hysiologically based understanding of the pathogenesis of petechiae of the head is critical for their appropriate interpretation. We present a review of the literature and the basis of our conclusion that conjunctival and fac ial petechiae are the product of purely mechanical vascular phenomena, unre lated to asphyxia or hypoxia.