A continuous, horizontal groove about 0.7 cm wide was observed on the nape and lower part of the face of a 93-year-old man. The groove started from one corner of the mouth, traversed the nape, and reached the other corner of the mouth. It was most conspicuous at the nape. The mark was considered to have been produced by an electric cord. No facial congestion was noted, however, a few petechiae were present in the conjunctivae. There were no wounds in the front of the neck, while small hemorrhages were noted in the neck muscles. The right 2nd through 6th ribs were fractured and slight hemorrhage was observed in the overlying muscle. There were no pathologic changes accounting for death. The presence of the so-called triad for an acute death suggested strongly that the most likely cause of death was acute asphyxia. The relationship between the cause of death and the mark was the matter at issue. The mark may have been produced by a hanging in an unusual position, but there was no indication that a hanging was performed. For a ligature mark due to strangulation, the level was too high. The possibility that the mark was produced when the victim was gagged seemed to be very low. Thus, it could not be confirmed whether the groove had any relation with a fatal assault. Reflex cardiac arrest by vagal stimulation when the neck was compressed was the most likely cause of death.