A traumatic experience

Doctors should consider domestic violence when taking histories. A 41-year-old divorced woman was admitted to the hospital with symptoms of a stroke. A computed tomographic scan found a cerebral blood clot. A clot in a woman of this age is unusual in the absence of a clotting disorder. The next day the patient's mother told doctors the woman's ex-husband had strangled her three months previously. Doctors decided the strangling had damaged the carotid artery, a clot had formed, and a piece had broken off, causing a stroke. Treatment dissolved the clot, but the patient remained paralyzed on one side. Domestic violence is common and happens to women of all races and socioeconomic groups. Associated medical problems include death, injury, suicide attempts, and premature labor. Children are also likely to be victims and to suffer adverse physical and emotional consequences. Doctors should question patients about domestic violence, and they should be prepared to counsel patients and provide referrals.