title: [Bilateral internal carotid thrombosis: search for strangulation, even very ancient].
abstract: BACKGROUND
  We report 2 cases of bilateral carotid thrombosis secondary to repeated attempts of strangulation.
  
  
  METHODS
  The first case was discovered in a 31-years-old woman who complained of psychiatric manifestations, memory loss and aphasia. Subsequently she developed hemiplegia which worsened under low dose aspirin. The second case occurred in a 41-years-old woman who presented with sudden hemiplegia and aphasia. Diagnosis of bilateral carotid thrombosis based on angiocomputerized tomography or angioRMI data which suggested dissection. Thrombosis location was similar: bilateral, symmetric, close to the carotid bifurcation. Both women had atherosclerosis risk factors: current smoking, use of estrogen containing pill, dyslipidemia and/or familial cardiovascular history. Search for thrombophilia was negative. Both women had been victims of intimate partner violence with repeated attempts of strangulation, but they were stopped 8 and 6 years before the diagnosis of carotid thrombosis. Several private interviews were necessary before knowing the exact cause.
  
  
  CONCLUSIONS
  Symmetrical bilateral thrombosis of internal carotids near the bifurcation should lead to evoke repeated attempts of strangulation, even if there are arterial risk factors, and especially if the patient is a middle-aged female. The therapy is not codified but prolonged anticoagulation is generally prescribed.
authors.affiliation: Service de médecine interne, groupe hospitalier Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75651 cedex 13, Paris, France. tieulie.n@chu-nice.fr <tieulie.n@chu-nice.fr>
authors.forename: N
authors.initials: N
authors.lastname: Tieulié
authors.forename: D L
authors.initials: DL
authors.lastname: Thi Huong
authors.forename: P
authors.initials: P
authors.lastname: Hausfater
authors.forename: P
authors.initials: P
authors.lastname: Duhaut
authors.forename: A
authors.initials: A
authors.lastname: Fur
authors.forename: B
authors.initials: B
authors.lastname: Wechsler
authors.forename: M
authors.initials: M
authors.lastname: Pelroth
authors.forename: J-C
authors.initials: JC
authors.lastname: Piette
mesh_terms: D000328:Adult; D001037:Aphasia / Q000209:etiology; D001237:Asphyxia / Q000150:complications*; D002341:Carotid Artery Thrombosis / Q000209:etiology* / Q000473:pathology; D017579:Domestic Violence; D005260:Female; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D012307:Risk Factors