JAMES Etherington died from a “severe head injury” when he hit his head on the pavement after falling outside Bijou nightclub, a forensic pathologist has said.

Dr Michael Parsons told the jury at Bradford Crown Court the headlock applied by bouncer Ciaran Spencer “could have rendered James more vulnerable to this kind of injury”.

Spencer, 25, of Green Head Drive, Keighley, denies the manslaughter of James Etherington, who was fatally injured outside the Bingley nightclub on November 25, 2017, and died ten days later.

Mr Etherington was ejected from the club after refusing to pay £4 for two shots, and in the process was put in a headlock by Spencer, before falling outside and hitting his head on the floor.

Dr Parsons said when paramedics attended the scene, Mr Etherington’s condition on the Glasgow Coma Scale was a score of three out of 15 - the lowest it can be - which represents “significant and profound unconsciousness”.

He said: “James had extensive bruising on the front half of his brain and swelling inside his skull.

“He also had a fracture at the back of his skull, and was put on a drain on the 26th to relieve pressure inside his head.

“The main fracture measured 11.5cm and there were three distinct fracture lines around his skull caused by the propagation of force through the skull.

“It all represents one heavy impact on the back of the head. There were no other injuries to any other parts of his body.

“If the pressure inside the skull exceeds the pressure of the blood coming to it, it cannot get the blood which causes brain damage, which we have seen here.

“It became very difficult to prevent very serious damage and his condition deteriorated and James died ten days later.”

A toxicology report revealed Mr Etherington had 255mg of alcohol in 100ml of blood, the equivalent of about nine pints of beer, and no drugs or other substances were detected.

Dr Parsons said there were three explanations for the injury; a simple fall or trip, being struck, or the headlock causing a loss of consciousness.

He said a simple fall was “a theoretical possibility but in my opinion an unlikely explanation”.

“It appears James is losing a degree of consciousness and when he falls he makes no attempt to put his arms out, which is a normal response even from drunk people,” Dr Parsons added.

“Immediately as the hold is released he falls; he simply drops. In my opinion alcohol does not have an impact on the fall.”

He also dismissed being struck as an explanation due to the CCTV.

“There is a strong possibility the method he was restrained could have been the most significant factor in his injury.

“Although the facts around this are unclear, the application of a compressive hold around the neck can result in a lack of consciousness and could have rendered James vulnerable to this kind of injury.”

In cross examination, Richard Wright QC asked Dr Parsons if he found any evidence “significant pressure” had been placed on Mr Etherington’s neck. Dr Parsons said he had not, but when he examined the body it was ten days after the initial incident.

Mr Wright also asked if a fall could have caused the injury, and if alcohol could have played a part.

Dr Parsons replied: "Yes, but I feel it is more theoretical than realistic.

"James is struggling inside the club but outside he is not doing the same. It's not possible to see how much pressure is applied to his neck, but it appears to me he had a reduced level of response.

"That is why I favour the neckhold as the most likely explanation rather than that he fell, but I cannot say definitively."

The trial continues.