Originally created 07/09/01

The warning signs of a stroke



Barbara Butler was dancing with her husband when it happened. Patricia Sims was arguing with her employer. A stroke stopped them both, one in mid-air, one in mid-sentence, like a sword cutting through the gossamer threads that link movement and memory and speech.

"All of a sudden my leg wouldn't work right," recalled Butler. "I started to shake it so it would begin moving again, and then my arm felt like it fell asleep. I told my husband, 'I don't think I can finish this. I have to sit down.' But by the time I got to a chair, I couldn't say anything."

"After my boss and I had this argument, we went on a break, and he followed me out and started to agitate me some more," said Sims. "I said to him, 'Not right now, you're not going to get me more upset,' and he said, 'Then you go back to work,' and I stood up real quick, and I felt my body go limp. I struggled to the stairs, but I couldn't feel nothing. My body was totally gone."

On the face of it, the lives of these Pittsburgh area women could not be more different. Butler is relatively affluent, a former ballet dancer who was in excellent shape when her stroke occurred. Sims was working two jobs to make ends meet and often didn't have enough food in her house to eat.

But they were alike in several critical aspects when they experienced their strokes about a year ago: both were in their late 40s, both knew they had high or at least borderline high blood pressure, and both were unaware of how much they were at risk for a stroke, which occurs when an artery bringing blood to the brain becomes clogged or ruptures, depriving a part of the brain of the oxygen it needs.

Their stories are all too common, say medical practitioners. More so then men, women tend to ignore or be unaware of the warning signs of strokes, especially women in their 40s or 50s who tend to think of strokes as an affliction of old age, when, in fact, a third of women stroke victims are under age 65.

Stroke is the third-leading cause of death in the United States, with about 600,000 occurring each year, killing 160,000 people. And while 57 percent of all stroke victims are men, women, on average, take 46 percent longer to get to hospitals than men, are less aware of stroke symptoms than men and wait 49 percent longer to see doctors, according to a 1998 University of Texas study.

Shortly after arriving for work, Sims had an ischemic stroke, the most common type, which occurs when a blood clot blocks a blood vessel or artery. Butler suffered a hemorrhagic stroke, when a spike in blood pressure causes a blood vessel to break, interrupting blood flow to the brain.

Either way, when brain cells die, abilities managed by that part of the brain also are lost. Depending on the number of cells affected, damage can range from weakness in an arm or a leg, to total paralysis in one side, to death.

Both women believe their injuries would have been much worse had their strokes not occurred in public places, which prompted others to quickly dial 911.

That, in fact, is the most critical step to treating a stroke, said Sims' doctor, Steven Goldstein.

"I think she was atypical in that she came to the hospital very quickly," said Goldstein, an associate professor of neurology at University of Pittsburgh Medical Center's Stroke Institute. "Her stroke occurred at 8:40 a.m. and she was at the hospital at 9:10, which is so important, since most of the worst damage is done within three hours of a stroke occurring."

Strokes of the type suffered by Sims can benefit from the quick administration of a tissue plasminogen activator, or TPA, which breaks up blood clots. But such treatment, which carries a risk of bleeding, would have been disastrous for Butler. Her stroke was caused by high blood pressure pumping through an overstressed artery, which split open "like a pipe bursting," she says.

"I knew I had borderline blood pressure," said Butler, noting that hers was generally at 130 over the high 80s. "What I didn't know was that it occasionally surged up to 210 over 100. It's like plumbing. Even if you have very good copper pipes, and water runs through them over the years occasionally at extremely high pressure, you will get leaks. It turns out I had forced blood through the vessels over the years, and one of the spikes came when I was dancing."

Sims, as a black woman, was at twice the risk for stroke. Up to 40 percent of all black adults have high blood pressure, compared with 20 percent for white adults. Doctors believe that diet, genetics and general lack of access to medical care and medication play a role in increasing risk; a current study is comparing African-Americans with high blood pressure to people of African descent to see what role is played by genetic, social and economic factors.

Today, Sims lives on Supplemental Security Income and food stamps. "If I didn't, I would be homeless." And because she's enrolled in a study of a cholesterol lowering drug, she gets that medication free.

Butler lost all feeling on her left side as a result of her stroke, and experiences constant burning pain ("If you take the worst sunburn and triple it, that's what it feels like") because her brain is misreading signals from that part of her body.

Rehabilitation was difficult. "When I first went into rehab, they wanted me to put these little pegs in holes, in three minutes. I couldn't even pick the peg up, forget about getting them into the holes. I just went back into my room and cried."

She took up knitting with a vengeance to strengthen her fingers and while she can't play the harp the way she used to, her dominant right hand wasn't affected.

If she could tell women anything about her experience, it would echo Sims' message of personal empowerment:

"I just think it's really important to pay attention to your body. And if you have high blood pressure, find out what to do about it. Get a blood pressure cuff, if you're borderline, and have your doctor show you how to take your own blood pressure several times a day.

"Don't just say, 'Oh, it's nothing."'

STROKE'S TOLL ON WOMEN

One hundred thousand young and middle-aged women will suffer a stroke in 2001.

Two-thirds of American women don't recognize stroke symptoms.

Sixteen percent of women hospitalized for stroke die, compared with 6 percent of male stroke patients.

Stroke is a leading cause of disability in women.

Female stroke survivors are more likely to have serious disabilities than men.

Fifty-six percent of caregivers are women.

MOST COMMON SYMPTOMS

Sudden numbness or weakness of face, arm or leg, especially on one side of the body.

Sudden confusion, trouble speaking or understanding.

Sudden trouble seeing in one or both eyes.

Sudden trouble walking, dizziness, loss of balance or coordination.

Sudden severe headache with no known cause.

RISK FACTORS

Increasing age

Gender: Stroke is more common in men than in women. However, more than half of total stroke deaths occur in women.

Heredity: Your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke. African Americans have a much higher risk of death from a stroke.

Earlier stroke or heart attack

High blood pressure

Diabetes mellitus

Carotid or other artery disease

Atrial fibrillation

Other heart disease

Transient ischemic attacks: TIAs are mini-strokes that produce stroke-like symptoms but no lasting damage. Recognizing and treating TIAs can reduce risk of a major stroke. Call 911.

High blood cholesterol

Tobacco use

Physical inactivity and obesity

Excessive alcohol use

Illegal drug abuse

Source: The National Stroke Association. For more information call the association at (800) STROKES or visit its Web site at www.stroke.org