Stroke: It's Not Just a Man's Problem

Women have different symptoms and the effects can be more disabling

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HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

FRIDAY, July 25, 2003 (HealthDayNews) -- The perception is that stroke is a "man's health problem."

Statistics prove it's not.

Strokes will kill an estimated 170,000 Americans this year -- and about 97,000 will be women, according to the American Heart Association.

What's more, women and men often experience markedly different symptoms. This may make it difficult to diagnose a stroke in women and, possibly, delay treatment, new research says.

"Either the experience of stroke is really different for some biological reason, or men and women experience the same phenomenon and explain it differently," says Dr. Lewis Morgenstern, director of the stroke center at the University of Michigan Medical School.

Most stroke patients describe roughly the same general collection of symptoms, including broken speech, facial paralysis, dizziness and various sensory problems.

But women are about 60 percent more likely than men to report other symptoms not generally associated with strokes, such as limb pain, disorientation and fluctuations in consciousness, Morgenstern says.

And women have more episodes of hemorrhagic -- or bleeding -- strokes than men, who are more prone to a blocked blood supply that triggers the attack. That may also partly affect the way each sex experiences the illness, Morgenstern says, but it doesn't fully explain the dichotomy.

Strokes occur when a blood vessel that transports nutrients and oxygen to the brain either is blocked by a clot or bursts.

In both cases, the area of the brain deprived of oxygen begins to die. And that, in turn, affects the part of the body it controls.

That women and men have different stroke symptoms shouldn't be surprising, experts says. Doctors have long known the two sexes often show dissimilar signs of other cardiovascular problems, most notably heart attack.

According to the American Heart Association:

  • Stroke is the third leading cause of death for American women, after diseases of the heart and cancer. It claims more than twice as many lives as breast cancer.
  • In the United States, women account for more than three of every five deaths from stroke.
  • The 2000 death rate for stroke was substantially higher for black women than white ones.
  • About 2.4 million American women are living with the aftermath of stroke.

Recent research also has revealed that a woman is likely to be older than a man when she has her first stroke, and that the stroke is often more disabling and severe.

Because these findings are relatively new, some medical professionals don't recognize some of the underlying conditions that can lead to a woman's stroke, some doctors say, and dismiss symptoms that might boost the risk of stroke in women.

Realizing all this, women should learn how best to reduce their risk of stroke and know when to ask for a thorough evaluation, experts say.

For instance, it might be especially important for women to keep blood pressure under control, says Dr. Jaume Roquer, a physician researcher at the Servei de Neurologia at the Hospital del Mar in Barcelona, Spain, who has researched gender differences in strokes.

There are also the usual preventive measures, such as not smoking, avoiding obesity and not abusing alcohol and drugs, he says.

Roquer and his colleagues recently evaluated 722 women and 809 men admitted to a hospital for a first stroke between 1995 and 2000. When they gathered information on the stroke, how the patients did after it and their risk factors, they found that women were more likely than men to have speech and visual problems and swallowing and chewing difficulty. Women's hospital stays averaged 15.4 days, compared to 13.4 for men. They were more disabled after the stroke, too.

The women studied also had higher rates of an irregular heart rhythm known as atrial fibrillation, in which the two upper chambers of the heart quiver rather than beat as effectively as they should.

Dr. Rosabel Young is another stroke expert who sees gender differences in her stroke patients.

"Generally women seem to have more embolic than thrombolic" stroke, says Young, a clinical assistant professor of neurology at the UCLA's David Geffen School of Medicine.

"While an embolic [stroke] is a clot that starts in the heart or the carotid artery [in the neck] and moves to the brain, a thromboembolic stroke involves a stationery clot in the blood vessels and small blood vessels," she says.

"Embolic is worse," Young adds, "and it has more complications. With embolic you have to treat essentially two organs, the brain, which has had the stroke, and the organ it came from, usually the heart."

For women, paying attention to physical symptoms, especially as they age, is crucial. And they need to take steps to safeguard against cardiovascular risk factors, both Young and Roquer say.

Women who have atrial fibrillation, Roquer adds, should probably be prescribed blood thinners, also called anticoagulants.

Those with symptoms of an irregular heart rhythm, such as dizziness, should take heed, too, Young says.

"There is a tendency for some medical professionals to think this is just anxiety or a panic attack. But if you have dizziness or 'panic attack' symptoms and irregular heart rate, you should be checked out thoroughly for heart disease or stroke," she adds.

Morgenstern says doctors should look for stroke in women complaining of unconventional symptoms because "time is of the essence" for effective treatments, such as clot-busting drugs.

"Trying to get past the clouds of what patients are saying could be very important for making a rapid diagnosis and instituting proper treatment," he says.

More information

For more on strokes and how to recognize them, visit the National Stroke Association or the National Institute of Neurological Disorders and Stroke. For details on stroke and women, check with the American Heart Association.

SOURCES: Rosabel Young, M.D., M.S., clinical assistant professor of neurology, David Geffen School of Medicine, UCLA, Los Angeles; Jaume Roquer, M.D., Ph.D., physician-researcher, Servei de Neurologia, Hospital del Mar, Barcelona, Spain; Lewis Morgenstern, M.D., director, stroke center, University of Michigan Medical School, Ann Arbor

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