A previously healthy five year-old boy was seen after intermittent strangulation attempts over the course of two days. Details of the event are vague due to lack of reliable adult witnesses. There was no indication of toxic exposure. General examination on arrival to the emergency department revealed an alert boy with bruising of the neck consistent with multiple strangulation attempts. There was no evidence of heart, kidney, or liver involvement to suggest systemic hypoperfusion or organ failure. Investigations done on arrival showed no acidosis, and a capillary blood gas 48 hours later revealed a normal carboxyhemoglobin. Although the initial neurologic exam was near normal, severe generalized dystonia developed over the next four weeks, requiring intrathecal baclofen treatment.