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More Than a Headache:
Recognizing and Minimizing Risks for Stroke
by Roberta Greenwood

It came without warning. As I was standing in the shower, my head began to throb – and then a crushing pain hit like a powerful punch. My vision faded, I could no longer hear, and all I could sense was a “rushing” sound in my skull. It was the most acute pain I’d ever felt, and it was overwhelming. I remember pushing my hands against the walls of the slick stall, attempting to remain upright. As nausea began to wash over me, an insistent inner voice told me what to do: Get out of the shower. Don’t fall down.

That was my personal introduction to the world of strokes. I was a healthy, 46-year-old woman with no indicators for risk and yet, on December 21, 1998, I was rushed to Torrance Memorial Medical Center in Torrance, California, the victim of a subarachnoid brain hemorrhage. In the instant the artery burst in the area surrounding my brain, I joined the nearly 700,000 Americans annually who suffer such sudden and often fatal attacks.

Strokes occur when a blood vessel is either blocked by a clot or bursts, depriving the brain of oxygen. Within minutes, part of the brain begins to die. Ischemic strokes (clots) are the most common. While nearly 25 percent of ischemic stroke patients enjoy a complete recovery, 30 percent suffer a disability that will affect their daily activities. Risk factors include high blood pressure, high cholesterol, smoking and diabetes.

Hemorrhagic strokes (burst artery or aneurysm) are often the result of undiagnosed vascular malformations that are present at birth and can run in families. When strokes occur as a result, they are sudden and severe; death rates for hemorrhagic strokes can run as high as 30 to 50 percent within the first three months of an attack. Many patients are left with disabilities that can be devastating to their families – and the number of young women suffering from strokes is on the rise.

Consider this: According to the American Stroke Association, a stroke occurs every 45 seconds in the U.S. and is the no. 3 killer and leading cause of disability in America. Alarmingly, 55 percent of all strokes occur in women, many under the age of 40.

Dr. Kyra Becker, director of the Stroke Clinic at Harborview Medical Center, says there’s some degree of denial when a woman suffers a stroke at a young age. “Often, she can’t believe it’s a stroke.” That denial can often lead to a delay in seeking treatment, which can lead to serious, sometimes fatal, consequences. According to the ASA, timing is everything when treating stroke patients. In the case of ischemic strokes, tPA, a clot-busting drug, must be given within three hours of the onset of stroke symptoms. The sooner that treatment begins, the higher the chance for a successful recovery, reports Dr. David Tirschwell, also of the Stroke Clinic. “Every second counts,” says Tirschwell.

Increased Risks
As research indicates that stroke is increasingly affecting women, studies by the ASA are investigating whether aging or hormonal levels affect risk. Because women live longer than men, more women die of stroke each year, accounting for 61 percent of U.S. stroke deaths in 2003. Postmenopausal women are at a higher risk, but younger women aren’t exempt from the dangers of stroke; those who suffer from migraine headaches, use oral contraceptives or smoke, are considered at risk. Even pregnancy and childbirth can increase the incidence of stroke, as blood clots form as nature’s way of stopping blood loss, and sometimes travel through the body and lodge in the brain. Studies at the University of Texas also indicate a connection between stroke and the rise in diabetes and hypertension – a fact that contributes to the high incidence of stroke in the African American population.

As with heart disease, prevention is the best treatment for stroke. Doctors at the ASA recommend that high blood pressure be treated as an urgent priority – and believe that if patients with high blood pressure were each treated promptly, the number of strokes in the U.S. would be cut in half annually. Eliminating smoking, treating high cholesterol, controlling diabetes and maintaining a healthy lifestyle are also measures that can significantly improve one’s chances for surviving a stroke. Dr. Becker says that while prevention is the best treatment, “early recognition of symptoms is also key to treating and surviving a stroke.”

Prevention and Treatment
The ASA offers this easy guide for determining whether treatment is required if stroke is suspected. Ask the patient to:

• Smile (look for one-sided facial weakness);
• Raise both arms (look for them to be raised at the same height);
• Speak a simple sentence (listen for slurring or confusion of words).

If someone exhibits any of these signs, seek emergency medical treatment. Treatment options will differ depending on the type of stroke suffered: Ischemic stroke patients often receive tPA in the first three hours, followed by ongoing medical intervention to prevent further blood clots from forming, and physical therapy. Hemorrhagic strokes often require repair of the artery – either through surgery or the insertion of a catheter – and follow-up treatment with the drug, nimodipine. New treatment modalities are also being explored throughout the U.S. and here in Seattle – some with encouraging success.

Angela Hughes, L.Ac, adjunct faculty member at Bastyr University and a licensed acupuncturist practicing at Providence-Mount St. Vincent Wellness Center, states that her stroke patients have seen dramatic improvements in mobility, increased sensation in limbs, improvement in speech and an overall decrease of pain. “In China, the first modality in the treatment of strokes is acupuncture,” Hughes reports. “It keeps energy flowing, which limits muscle waste due to the lack of circulation. With prompt and effective treatment, we can enhance the quality of patients' lives.”

Excellent stroke prevention and treatment centers are available nationwide. While most hospitals are capable of treating stroke patients, stroke centers can offer the most current and comprehensive treatment plans available. The Seattle area has several top-rated facilities, including the University of Washington Stroke Center at Harborview Medical Center, which was rated third in the nation in a 2005 benchmarking project.

As a stroke survivor, I know firsthand how critical it is to receive immediate, effective treatment at the first indication of symptoms. Within days of my stroke, I was home, enjoying short walks around my neighborhood. Four months later, at my final appointment with my neurosurgical team, I was delighted to hear that I could resume my life with no limitations. I’m one of the lucky ones.

Strokes can happen to any of us. Take the time to educate yourself, reduce your risks, and know the symptoms.

Roberta Greenwood is a frequent contributor to Seattle Woman magazine and a stroke survivor. She’s currently training to participate in the 3-Day, 60-Mile Breast Cancer Walk in San Diego, CA.

©2006 Caliope Publishing Company