Strokes—The Number 3 Ladykiller

It is a frequent misnomer that strokes are a man’s disease. The truth is, in the United States and Canada, more women than men die from strokes each year. It is the number three cause of death among women, behind heart disease and cancer. As always, knowledge is power. About 80% of strokes can be prevented. Learn about what a stroke is and what the warning signs are. Find out what the risk factors are for both genders and what dangers are specific to women. Taking preventative measures and seeking quick treatment can make all the difference.

The Brain Attack

A stroke is generally defined as a sudden interruption of blood supply to a part of the brain. It is considered a cardiovascular disease which affects the arteries that lead to the brain as well as the blood vessels within the brain itself. When blood vessels carrying oxygen and nutrients become clotted by a blockage, or burst within the brain, the region of the brain affected cannot receive the blood it requires, and brain cells begin to cease functioning and die.

There are two fundamental types of stroke, Ischemic and Hemorrhagic.

An Ischemic stroke occurs when an artery to the brain is blocked, interrupting the circulation of blood from the heart and lungs. Normally, the blood carries oxygen and nutrients and removes carbon dioxide and cellular waste. When a disturbance happens, the brain cells cannot generate enough energy, causing brain tissue to die. It is the most common type, amounting to about 80% of all stroke cases.

The arterial obstruction is due to a build-up of fatty deposits lining the walls of the blood vessel, and this can happen in two ways: Thrombosis is a blood clot that narrows the vessel canal gradually, impeding the flow of blood to tissue. An embolism is a clot that forms elsewhere in the circulatory system, eventually breaking away and traveling through the bloodstream until it meets vessels too small to allow it passage.

Hemorrhagic strokes, on the other hand, are the result of a ruptured blood vessel causing bleeding inside the skull. Otherwise known as a cerebral hemorrhage, the damage is twofold; the bleeding vessel is unable to carry blood to its intended tissue, and the presence of blood on the brain itself also kills neural cells. If the bleeding persists, intracranial pressure may develop which will also restrict blood flow to the brain. Intracerebral hemorrhaging refers to a rupture deep within the brain, while a subarachnoid hemorrhage is bleeding on the surface of the brain.

Symptoms

Learning to recognize the warning signs of a stroke can dramatically impact the individual’s ability to recover from it. Every second counts, and the saying goes that “time lost is brain lost”. Sudden numbness of the face, arm, or leg is a predicator of the onset of a stroke, particularly on one side of the body. Confusion, dizziness, loss of balance and coordination, severe headache, trouble speaking, loss of vision in one or both eyes, and difficulty walking, are some of the initial symptoms of a stroke.

Women may report different symptoms. These include pains in the face and limbs, hiccups, nausea, chest pain, shortness of breath, heart palpitations, and general weakness.

If you suspect someone of having a stroke, ask him or her to smile, to raise both arms, and to repeat a simple sentence. If one side of the face or body droops, or if the words are slurred and the subject is unable to repeat the sentence correctly, you are advised to call 911 immediately.

A mini-stroke, otherwise known as a Transient Ischemic Attack (TIA), could be a precursor for a major stroke later. While a stroke will permanently block blood flow to the brain, a TIA is a temporary blockage that bears the same symptoms of a stroke. Eventually, the clot becomes unblocked, and the symptoms will go away after a short time.

Stroke Management

If treated within the first three hours, the long-term effects of a stroke can be drastically curtailed. Tissue plasiminogen activator (tPA) is a clot-bursting drug that is administered through an IV for certain patients who have had a heart attack or stroke. By dissolving blood clots, it may reduce the amount of damage an ischemic stroke can cause. More than half of stroke patients who receive this treatment report minimal disabilities or recover completely.

People who experience ischemic strokes may be on medications for the rest of their lives to ensure low cholesterol and to control blood pressure and clotting.

Surgery may be employed in cases of hemorrhagic stroke in order to remove blood pooled on the brain, to relieve intracranial pressure, to repair damaged blood vessels, and to remove blockages inside the carotid artery. Referred to as plaque, these blockages may also be removed by using a thin catheter applied directly into the blood vessels or the brain.

Depending upon which part of the brain was affected during the stroke, physical effects include a loss of movement on the right or left side, speech problems, difficulties breathing, swallowing, balancing, hearing, as well as a loss of vision. Sometimes unaffected parts of the brain will take over vital functions that were damaged or lost during the stroke.

Through patience and hard work, the scope of disabilities can be decreased. There are many rehabilitative professionals to help patients cope with the effects of a brain attack. Physical therapists can help to regain lost mobility through heat and massage therapy, and guided exercise. Occupational therapists help patients to relearn basic abilities, with a focus on skills required for independent living, such as bathing, cooking, and buttoning up a shirt. Speech therapists can help the individual to regain language and communication skills. Psychiatrists and support groups can help overcome the effects of depression, which happens to one-third of people post-stroke.

Who is Affected?

Statistically, people over the age of 55 are at a higher risk of having a stroke, a risk that doubles every decade thereafter. Family history is another indicator, with a greater chance of developing if a member of the immediate family has suffered a stroke. A prior history of heart attacks or TIAs will also heighten the risk of a major stroke.

While genetics, gender, age, and ethnicity are uncontrollable factors that may account for your risk of a stroke, lifestyle choices and untreated diseases can contribute to its development.

Hypertension (high blood pressure) forces the heart to pump harder in order to force blood through the body, and as a result could weaken blood vessels. A normal blood pressure is below 120/80. High blood pressure usually has no symptoms but is the most common cause of stroke, increasing risk 4-6 times. 

Atrial Fibrillation (irregular or rapid heartbeat) happens when two upper heart chambers beat rapidly and unpredictably. By allowing blood to pool in the heart, it could form clots that can travel to the brain.

High Cholesterol in the bloodstream, created naturally by the body or by eating a lot of fatty foods, can clog arteries.

Other factors that increase the risk of stroke in both men and women include diabetes, obesity, smoking, excessive alcohol consumption, stress, and lack of physical exercise.

Risks Unique to Women

More women die from strokes than men. Certain factors unique to women can be responsible for the onset of stroke.

Birth control pills may cause high blood pressure and blood clots, an issue that is compounded if she is over the age of 35 and smokes cigarettes. If a woman already has high blood pressure or a blood clotting problem, oral contraceptives can augment this risk further.

Pregnancy could increase the risk of heart disease due to the natural bodily changes that occur through gestation. The danger of stroke is greatest six weeks after childbirth. Pre-eclampsia is a condition that increases blood pressure and protein in urine. It usually occurs after 20 weeks of pregnancy to approximately 7% of pregnant women. Due to hormonal changes throughout pregnancy, a woman’s body needs to produce more insulin; if she cannot process this extra insulin properly, gestational diabetes could develop.

Estrogen plays a vital role in a woman’s cardiovascular health. Around age 50, menopausal women will experience a lack of estrogen as their ovaries slowly stop producing this coronary-protecting hormone. With this change comes a greater likelihood for higher blood pressure, blood clotting, and diabetes. She may also experience an increase in bad cholesterols and triglycerides, and a decrease in good cholesterols.

Triglycerides are the most common type of fat in the body. A high level of blood fat, more than 128 milligrams per liter, may increase the odds of stroke by five times.

Women seeking to avoid the effects of menopause are advised against taking Hormone Replacement Therapy (HRT), by both the Heart and Stroke Foundation and the American Heart Association. Studies as yet have not proven that HRT reduces the risk of heart disease or stoke.