Did you know that signs of a stroke can be different in women than men? This, plus risk factors you may not know about, make stroke a leading killer of women. Here’s the info you need.

Why symptoms are different

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If you’re at risk for a stroke, one acronym could save your life: FAST, developed by the American Stroke Association (ASA), which stands for face drooping, arm weakness, speech difficulty, and time to call 911. But these aren’t the only or even most obvious stroke symptoms in women, says Cheryl Bushnell, MD, professor of neurology at Wake Forest Baptist Medical Center. “We have no idea why the stroke symptoms might be different for women. We need research on this topic.” Women also have unique risk factors—their hormones can play a role—making stroke the third leading cause of death in women.

Fainting or seizures

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You might be tempted to minimize a fainting spell, but it could be a stroke: Women tend to suffer strokes to the back of the brain more often than men, says Diana Greene-Chandos MD, FNCS, assistant professor of neurosurgery and neurology at The Ohio State University Wexner Medical Center. Known as posterior circulation strokes, they cut off “blood flow to the occipital lobes, brainstem, cerebellum, and part of the temporal lobe. The top of the brainstem is where the consciousness center lies,” Dr. Greene-Chandos says, and cutting blood flow to this part of the brain can lead to fainting. She notes, however, that fainting “could also be related to a hyperventilation response to any type of stroke, as a fear response,” and that seizures, another of the stroke symptoms in women, can also be confused with a loss of consciousness.

Difficulty breathing

Old woman experiencing chest pains, having a heart attack or stomach acidDAN KOSMAYER/SHUTTERSTOCK

Although women would think chest pain and shortness of breath are signs of a heart attack, it could be a stroke. “This is consistent again with posterior circulation problems from the bottom of the brainstem where the respiratory drive centers lie,” says Dr. Greene-Chandos. Early recognition of stroke signs is crucial, says Kathryn Rexrode, MD, chief of the Division of Women’s Health, Brigham and Women’s Hospital. “It is important to get prompt emergency care if you are experiencing stroke symptoms since some strokes can be stopped by use of thrombolytic, or clot-busting, drugs,” she adds.

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According to a survey from Dr. Greene-Chandos and colleagues at The Ohio State University Wexner Medical Center, only ten percent of women surveyed knew that hiccups, combined with atypical chest pain, are among the early stroke symptoms in women. “Hiccups are consistent with posterior circulation problems from the brainstem,” Dr. Greene-Chandos says. “The brainstem holds swallowing and the drive to breathe,” along with other functions.

Sudden behavioral changes or agitation

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Women are half as likely to report a non-traditional stroke symptom compared to men, according to findings from the University of Michigan; the most common of these symptoms was a shift in a woman’s mental state. Dr. Greene-Chandos believes this could be consistent with a posterior circulation stroke, which could target areas responsible for memory and personality. However, the frontal lobe is also tied to personality, so behavior changes “could be due to a frontal lobe stroke as well,” she says.

Nausea or vomiting

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A stroke in the cerebellum can also lead to dizziness, nausea, and vomiting, Dr. Greene-Chandos says. “This is consistent with posterior circulation problems from either the brainstem or the cerebellum.” It can also be seen in intracranial hemorrhage-type of strokes as well, she says, in which a bulging blood vessel (an aneurysm) bursts and causes bleeding into the brain. These are the scary signs of a brain aneurysm everyone should know.

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