Wake-up call on stroke in women

The Family Health Guide

Most of the 700,000 people who have strokes each year in the United States are women, and more women die of strokes than men do. Among stroke survivors, women are more disabled and more likely to enter a nursing home. For years, it's been thought this disparity exists mainly because women live longer and tend to have strokes later in life.

But research shows a worrisome gender difference even in midlife. According to a study, women ages 45 to 54 are more than twice as likely as men to suffer a stroke (Neurology, published online, June 20, 2007).

When a stroke occurs, brain cells die quickly, so it's critical to get help immediately. The severity of the impact depends on factors such as the location of the stroke, the extent of tissue damage, and how quickly symptoms are treated.

Types of strokes

Brain cells require a constant supply of oxygen- and nutrient-carrying blood. A stroke suddenly interrupts that supply. In ischemic strokes, which make up more than 80% of all cases, the cause is a blood clot blocking an artery supplying the brain.

If the blood supply is interrupted only temporarily, so that symptoms go away in less than a day, it's called a transient ischemic attack (TIA), or a warning stroke. A TIA must be taken seriously and treated as an emergency, because at the start, there's no way to distinguish it from a full-blown stroke, and because about one-third of those who experience a TIA will go on to have a full stroke, often within a year.

Slightly less than 20% of strokes are hemorrhagic strokes, in which a blood vessel in the brain bursts.

What are the symptoms?

Because the brain controls all the body's functions, stroke symptoms can take many forms, including these:

Numbness or weakness in the face, arm, or leg. The symptoms may include a drooping face, slurred speech, or paralysis of a limb. Often only one side is affected.

Confusion. A stroke can make it difficult to speak or understand words (aphasia).

Vision problems. Vision may dim or be lost entirely in one or both eyes. It may also become difficult to move the eyes.

Trouble walking. Stroke can cause staggering, poor balance, and a sense of dizziness, clumsiness, or impaired coordination.

Severe headache. A stroke may cause a sudden, violent headache.

If you have any of these symptoms, or observe them in someone else, call 911. Note the time when the symptoms began, and, if possible, bring a list of medications (or the prescription bottles themselves) to the hospital with you.

Unlike a person having a possible heart attack, a person who might be having a stroke should not take an aspirin, because aspirin might worsen the bleeding caused by a hemorrhagic stroke.

Could you recognize stroke in someone else?

If you suspect someone is having a stroke, think FAST:

  • Face. Ask the person to smile. Is one side drooping?
  • Arms. Ask the person to lift both arms. Does one drift back down?
  • Speech. Ask the person to repeat a simple sentence. Is it slurred or incomplete?
  • Time. If one or more stroke signs are present, act quickly. Call 911, and get the person to the nearest hospital with an emergency department — and, if possible, one with a stroke center.

At the hospital

A physician will assess your symptoms and take your medical history. If the doctor believes it's a stroke, she or he will perform brain imaging to determine whether it is ischemic or hemorrhagic.

Using tPA

The chief FDA-approved medical treatment for people experiencing an ischemic stroke is tissue plasminogen activator (tPA), or alteplase, an enzyme that dissolves blood clots. For best effects, tPA must be delivered intravenously within three hours of the onset of symptoms. The physician must be sure the person is actually having a stroke and that there is no bleeding in the brain.

Other ways to address clots

According to guidelines from the American Stroke Association, physicians may consider two other therapies when tPA can't be used or the clot does not respond to it.

One approach is to deliver a clot-dissolving drug directly to the site of the clot through a catheter. The other is to remove the clot by means of a catheter device called the Merci retriever. The physician makes an incision in the groin and threads the device up to the carotid artery, which feeds the brain. Once it reaches the clot, the retriever snares and removes it.

When the diagnosis is TIA rather than a full stroke, evaluation and treatment focus on identifying and addressing possible causes of artery blockage. A clinician may use ultrasound to check the carotid arteries in the neck for narrowing or clotting. Medication to reduce clotting may be prescribed.

Stopping a brain bleed

Hemorrhagic stroke is less common but more often lethal than ischemic stroke. During a hemorrhagic stroke, physicians will aid breathing and use medications to control seizures, reduce brain swelling, maintain normal blood pressure, and ease pain. Depending on the source of the bleeding, surgery may also be necessary.

Neurologists are also investigating neuroprotective drugs, which would shield brain cells from the damage caused by interrupted blood flow in both ischemic and hemorrhagic stroke.

October 2007 update