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Stroke is the third leading cause of death in women, yet many think of it as a condition affecting men.
Women should make sure they know how to prevent a stroke and notice its signs and symptoms.
A Swedish neurologist explains how strokes affect women
Did you know that more women die from strokes than men each year? Strokes are the third leading cause of death for women. The Centers for Disease Control and Prevention estimates that one in five women have a stroke between ages 55 and 75. But, four in five strokes are preventable.
The key is knowing how to prevent a stroke and noticing when someone is having a stroke.
To learn more, we spoke with Aaron Stayman, M.D., neurologist at Swedish Neurology – Cherry Hill, who offers helpful information about how strokes affect women.
Q: Please give a brief overview of a stroke. What is it? What causes it? And what happens to the body during a stroke?
A: A stroke is a sudden injury to the brain that’s caused by bleeding or interruption of blood flow to brain tissue.
Ischemic stroke, which accounts for 87% of strokes, results from blockage of a blood vessel. The brain cells that rely on that blood vessel become deprived of oxygen and nutrients and begin to rapidly die. Hemorrhagic stroke, which is less common, occurs when a blood vessel ruptures inside the skull — often resulting in a sudden, severe headache.
When you have a stroke, you experience symptoms related to the part of the brain that’s losing brain cells. The obvious symptoms are weakness on one side of the body, facial droop, slurred speech, and loss of vision. Some strokes can cause problems with producing and understanding language. Others can lead to difficulties with perception and attention. Strokes that affect the brainstem can cause double vision, vertigo, loss of balance and changes in one’s level of consciousness (even coma).
Nearly 800,000 strokes happen every year in the U.S. It’s important to understand that most strokes are not fatal. However, they are the leading cause of disability. Half of stroke survivors have a moderate to severe disability that affects their ability to work, drive, perform self-care, socialize, and more.
Swedish patient Deonna Keiser is an artist who is living with the impacts of speech aphasia and apraxia as a result of a stroke. While Deonna is able to understand all spoken language, she sometimes has trouble formulating the words to speak. With the help of her dear friend Lisa Naser, and through her art, Deonna is able to communicate her day-to-day and emotional experiences. Many stroke survivors experience aphasia and apraxia. We are grateful to Deonna and Lisa for sharing their story with us.
Q: Are women at a higher risk of a stroke? What increases a woman’s risk?
A: Statistically, stroke occurs in men more often than in women. However, in people 80 or older, stroke is more prevalent in women than men.
Anyone can have a stroke, even young adults and children (though it’s much less common). In both men and women, age and certain conditions increase your risk for strokes, such as high blood pressure, diabetes, high cholesterol, kidney failure, obstructive sleep apnea and a heart arrhythmia called atrial fibrillation. Lifestyle factors also can increase stroke risk. These include obesity, lack of exercise, tobacco use, drug use (particularly cocaine and methamphetamine) and heavy alcohol use.
There are additional factors unique to women that affect stroke risk:
- Early age of menarche or menses (the start of your periods before age 10) is associated with increased risk of stroke.
- Early menopause (before age 45) is associated with increased risk of heart attacks. The same was thought to be true for ischemic stroke risk, but population studies have not confirmed this.
- Use of estrogen-containing hormonal contraceptives is associated with an increased risk of ischemic stroke compared to non-users. Progestin-only birth control has not been shown to increase risk of stroke.
- Use of estrogen hormonal replacement for the treatment of hot flashes and night sweats during menopause was thought to increase risk of stroke. Studies have shown that use of hormone replacement therapy early in menopause has little effect on stroke risk. Conversely, hormone replacement 10 years after menopause can increase stroke risk.
- Pregnancy creates a unique set of factors that can increase stroke risk in a young person.
Q: Can you tell us more about pregnancy-related strokes? Are they common?
A: Stroke during pregnancy is not common. Generally speaking, stroke in young adults is rare, but pregnancy and the time after childbirth are associated with a three-fold increase in stroke risk compared to non-pregnant young adults.
Pregnancy-related conditions that cause high blood pressure can lead to ischemic and hemorrhagic stroke. Conditions include gestational hypertension, pre-eclampsia and eclampsia.
Pregnancy and the postpartum period also are associated with a hypercoagulable state, which means a greater tendency for the blood to form clots. This can lead to clots in the large veins that carry blood away from brain tissue (called dural sinus thrombosis), which can cause ischemic and hemorrhagic strokes.
Other rare causes of stroke in pregnancy include peripartum cardiomyopathy (a weakening of the heart muscle during pregnancy), dissection (tear) of neck arteries during labor and stroke caused by amniotic fluid entering the bloodstream.
Q: Are African American women at higher risk for stroke? If so, why?
A: There are well-documented racial disparities with strokes. African Americans are more likely to experience hemorrhagic and ischemic stroke compared to white Americans around the same age. A similar disparity also occurs in Hispanic and Native American populations.
African American women are 50% more likely to have a stroke compared to white women. There has been a decrease in death from stroke in the last decade, which is considered a major public health victory. Unfortunately, the decrease in stroke deaths for African Americans has not been as robust.
Several factors have been linked to these health disparities. Population studies have identified a higher prevalence of stroke risk factors, such as high blood pressure and diabetes, in African Americans. Socioeconomic inequality in minority communities also is a contributor. Lower-income individuals have less access to preventive health care and affordable options for good nutrition.
Q: What are the signs of a stroke for women? Are they different than stroke signs for men? What should women watch out for?
A: Women experience the same traditional signs and symptoms of a stroke as men. Women, however, are more likely to experience non-traditional symptoms too, such as headache, lightheadedness, disorientation, general weakness, hiccups, nausea, fatigue and blurry vision.
Because none of these symptoms are specific to stroke, they can potentially lead to delays in diagnosis. So, how do you know when to get medical help for mild or ambiguous symptoms? If you have unfamiliar symptoms that start suddenly and you have multiple stroke risk factors (older age, high blood pressure or diabetes), you should seek medical attention.
Q: What treatments and services are available to help with stroke?
A: There have been many advances in the acute treatment of stroke. For example, medications that can dissolve blood clots in arteries and surgical treatments to retrieve clots from the brain. These exciting therapies can, for some, lead to reductions in disability and symptoms.
Rehabilitation specialists — rehab doctors and physical, occupational and speech therapists — work diligently with patients to help with stroke recovery. But I believe primary care providers are doing truly meaningful work. Family doctors, internists, nurse practitioners and physician assistants can help prevent strokes by treating diabetes, high blood pressure, high cholesterol and sleep apnea and helping their patients quit smoking. Prevention is key since about 80% of strokes can be prevented. Patients should work closely with their health care provider to understand their own risk for stroke and what they can do to lower it.
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If you have questions about strokes, contact the Neurology department. We can accommodate both in-person and virtual visits.
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