Neurological
Acute central nerve neurological problems are associated with severe beating to the head. Of 200 torture victims, 58% had received severe beating to the head and 1/4 of those consequently lost consciousness (Rasmussen, 1990). Headaches were the most frequently reported symptom, present in more than 50% of the examined persons. A significant correlation between severe beat- ing to the head and headaches was found. Likewise, there was a significant association with the symptom vertigo present in 20% of the persons.
Violent shaking may produce cerebral in- juries identical to those seen in the shaken baby syndrome: cerebral oedema, subdural haematoma and retinal haemorrhages.
Acute peripheral nerve symptoms are most often reported as a result of handcuffs or tight ropes at the wrist. Lesions of the brachial plexus, especially the lower roots, have been mentioned after suspension, and damage to the long thoracic nerve has been reported after “Palestinian hanging”.
Many of the long-lasting symptoms, such as loss of concentration, headaches, memory disturbances and vertigo, could be explained by chronic, organic brain damage and call for a neurophysiological evaluation in order to evaluate the specific symptoms. It should, however, be borne in mind that many of these symptoms are also related to PTSD.
Many forms of torture can cause nerve damage, including stretching injuries associated with joint damage and physical damage from fractures and incisions. The speed of resolution of nerve damage is relatively predictable, so it may be possible for an expert to determine the approximate time of the original injury from a series of examinations over several months.
‘Palestinian suspension’ can lead to neuropathy of the brachial plexus, especially if it has been prolonged. Sometimes there will be residual signs of this, and if they are still present after two years, they will probably be permanent. ‘Winging’ of the scapula must be looked for (by asking the person to push against a wall and observing the shoulders from behind). Survivors will sometimes describe having suffered weakness of the muscles around the shoulder associated with the loss of certain movements which have recovered progressively over a period of months. If he or she did not have access to information about the clinical processes involved, this description can be very supportive of allegations of torture. Often there is residual pain around the chest and shoulder joint which may be partially or completely physical or may be psychosomatic.
Peripheral nerve lesions of the hands and feet may also be detected following the prolonged application of restraints (wires, ropes, handcuffs, etc.) to the wrists or ankles. Motor and sensory changes may be transient or, in cases of excessive and prolonged tightening, may be permanent. These lesions are sometimes known as handcuff ‘neuropathies’.
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