This distinction rests on the presence or absence of a vital reaction — the body's living response to injury. All the signs below are present in antemortem hanging and absent (or non-characteristic) in postmortem hanging.
| Feature | Antemortem Hanging | Postmortem Hanging |
|---|---|---|
| Ligature mark | Well-defined | Less distinct |
| Base of ligature mark | Pale, dry, hard, parchment-like | Soft, pale, no parchmentization |
| Vital reaction | Present | Absent |
| Abrasion/ecchymosis around mark | Present | Absent |
| Dribbling of saliva | Present | Absent |
| Subcutaneous tissue beneath mark | Glistening, white and compressed | No characteristic change |
| Neck muscle hemorrhage | Present | Absent |
| Carotid intimal tear (Amussat's sign) | May be present | Absent |
| Jugular intimal tear (Martin's sign) | May be present | Absent |
| Congestion of organs | Present | Usually absent |
| Petechial hemorrhages | May be present | Absent |
| Signs of asphyxia | Present | Absent |
| Microscopy | Vital inflammatory reaction present | No vital reaction |