My understanding, correct me if I'm wrong, is that death BY strangulation is uniquely determined ONLY by patechial hemorrhaging of the WHITE area of the eyes and not the eyelids. THAT kind of hemorrhaging can be caused by other factors. That's how I read it (I think the Mayo clinic website).
No. She died of strangulation; that cord was imbedded in her neck so deeply that Det. Arndt and John Ramsey didn't even see it when her body was brought up from the basement.
I'm not medically inclined to be able to explain it correctly, but basically, manual strangulation cuts off the air supply more quickly than the blood supply to the brain - and often breaks the hyoid bone.
The garotte cord was 3/8" wide and had a slip knot at the back that was tightened - possibly slowly, loosened, tightened, loosened. It wasn't moved from its track, only slightly deviated upward from it, so that is just a theory.
There's also the possibility of a vagal response to the cord tightening, which slows the heart almost to nil. The vagus nerve is a cranial nerve. The response is to constrict both the blood flow and the air supply. When done purposely (pervs do it for fun), it can kill.