l	

Stroke
 If you are having a stroke, you need to be taken to the hospital 

right away. Thankfully, there are stroke treatments that can 

increase your chances of walking away from an attack with few 

or no disabilities. But you have to get these treatments within 

3 hours from the start of your symptoms for them to work. Be 

aware of the signs of stroke so you can help yourself or someone 

else get vital treatment. 

What is a stroke? 

A stroke occurs when part of your brain 

doesn’t get the blood that it needs. A 

stroke is sometimes called a “brain 

attack.” This is because, like a heart 

attack, a stroke involves the loss of blood 

flow, leading to the death of cells. In fact,

without blood, your brain cells start to 

die within minutes. 

There are two types of stroke: 

Ischemic (ih-SKEE-mik) stroke— 

When a blood vessel bringing blood 

to the brain becomes blocked. For 

instance, a blood clot may form within 

What are the symptoms of a stroke? 

A stroke happens fast. The most common signs of a stroke are sudden: 

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

• trouble seeing in one or both eyes 

• trouble walking, dizziness, or loss of balance or coordination 

• confusion or trouble speaking or understanding 

• severe headache with no known cause 

If you have any of these symptoms or see anyone with these symptoms, call 911 

right away. Every minute counts! 

Stroke 37 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

l	

ISchemIc STroke 

the heart or an artery in the neck.

The clot is carried by the blood to the 

brain, where it gets stuck in a smaller 

artery. There, it cuts off blood flow to a 

part of the brain. About 80 percent of 

strokes are ischemic strokes. 

Hemorrhagic (hem-ur-RAJ-ihk) 

stroke—When a blood vessel in or 

on the surface of the brain breaks 

open. As a result, blood flows into the 

wrong areas. This blood, which would 

normally supply brain cells with oxygen and nutrients, can no longer get 

to these cells. Also, this blood in the 

wrong areas puts pressure on nearby 

brain cells. For both of these reasons,

brain cells die. In an intracerebral (ihntruh-suh-REE-bruhl) hemorrhage,

the blood flows into the brain itself. In 

a subarachnoid (suhb-uh-RAK-noid) 

hemorrhage, the blood flows into a 

thin space outside the brain but still 

inside the skull. About 20 percent of 

strokes are hemorrhagic strokes. 

If you’re having a stroke, you may not 

be able to call 911. In fact, you may 

not even be able to move or talk! In 

most stroke cases, it’s a family member,

coworker, or other bystander who calls 

911. That’s why everyone should become 

familiar with the signs of a stroke. 

What is a “mini-stroke”? 

If you have signs of a stroke that don’t 

last long, you’ve had what is called a 

transient ischemic attack (TIA), or 

“mini-stroke.”TIAs typically last from 5 

to 15 minutes, with no lasting symptoms.

They are often caused by a blood clot 

getting stuck in a brain artery for a short 

time but then breaking up, allowing 

the blood to flow freely again. If your 

symptoms last longer than 24 hours,

then you’ve had a major stroke rather 

than a TIA. 

If you’re having stroke symptoms, 

there’s no way of knowing whether 

you’re having a TIA or a major stroke. 

You should still call 911 as soon as 

possible. 

Even a “mini-stroke” is considered a 

stroke and needs treatment. A TIA is 

often a sign that you may have a major 

stroke in the near future—perhaps in the 

next few days. Your doctor may prescribe 

medicines or surgery that may help you 

38 The Healthy Woman: A Complete Guide for All Ages 
avoid having a major stroke that could 

cause lasting damage. 

Your doctor madoctor may giv ou aspir give you aspirin 

or some other drug to reduce blood 

clotting. Your doctor may also 

recommend a type of surgery called 

carotid endarterectomy (kuh-ROT-ihd 

en-dar-tuh-REK-tuh-mee). In this 

procedure, the carotid artery in the neck 

is opened up and plaque is removed from 

the artery walls. This allows the blood 

to flow more freely in the artery and 

reduces the chances of a clot forming. 

Another way to open a clogged carotid 

artery is to insert a stent. A stent is a 

tiny, slender metal-mesh tube that can be 

expanded to keep an artery open. A stent 

placed in a carotid artery is very similar

to a stent placed in an artery in the heart 

for treating coronary artery disease. (See 

page 31 of the Heart Disease chapter for 

more information on stents.) 

Who is at risk of having a stroke? 

Although anyone can have a stroke,

some people are at higher risk than 

others. You have no control over some 

risk factors for stroke, such as your age or 

sex. But there are many risk factors that 

you can change or control, such as high

blood pressure or cigarette smoking. 

Stroke and heart disease share many of

the same risk factors. The good news 

is that 80 percent of strokes can be 

prevented by changing or controlling 

certain risk factors. 

Stroke risk factors that you cannot change 

Previous stroke. Having had a previous 

stroke is the biggest risk factor for 

having another stroke. 

Age. For every decade after the age of 

55, your stroke risk doubles. 

Sex. If you consider all ages, men are 

more likely to have strokes than women.

But between the ages of 45 and 64,

women are more likely to have strokes 

than men. This is probably because blood 

pressure and cholesterol (koh-LESStur-ol) levels rise more quickly in women 

than men during this period. High blood 

pressure and poor cholesterol levels are 

both risk factors for stroke. 

Menopause. The risk of stroke increases 

after menopause. 

Race. African Americans are more 

likely to have a stroke than other people.

This is partly because African Americans 

are more likely to have certain isk fa e certain risk fac-­

tors, such as high blood pressure and 

diabetes. 

Stroke family history. If stroke runs 

in your family, it may be because your 

Stroke 39 
 

 

 

 

 

 

 

 

 

 

 

 

family carries genes that increase your 

chances of having a stroke. An example 

would be genes that increase your 

chances of forming a blood clot. Or it 

may be that your family has a lifestyle 

that increases your chances of having a 

stroke. For example, your family may eat 

a diet high in saturated fat. 

Stroke risk factors that you can change 

High blood pressure. High blood

pressure is the biggest risk factor for 

stroke. In fact, it increases your chances 

of having a stroke 4 to 6 times. 

For information on risk factors for heart 

disease, see the Heart Disease chapter on 

page 15. 

Heart disease. The second biggest risk 

factor for stroke is heart disease, especially 

a disease called atrial fibrillation (fib-ruhLAY-shuhn). In atrial fibrillation, the 

upper chambers of the heart beat faster 

and more irregularly than the rest of 

the heart. As a result, blood doesn’t flow 

through these chambers correctly and can 

clot. A clot may then dislodge and travel 

up to the brain, where it can cause an 

ischemic stroke. 

Blood cholesterol levels. High LDL 

(bad) cholesterol and low HDL (good) 

cholesterol levels increase your risk of 

stroke. They do this by causing the buildup of plaque. 

Plaque and Atherosclerosis 

Plaque is a fatty substance that builds 

up in the walls of arteries. Plaque is 

made up largely of cholesterol and fat. 

The narrowing and hardening of arteries caused by plaque buildup is called 

atherosclerosis (a-thuh-roh-skluh-rohsuhss). 

Cigarette smoking. Cigarette smoking 

has been linked to plaque buildup in the 

carotid artery. Other ways that cigarette 

smoking increases your stroke risk 

include: 

l	 The nicotine in cigarettes raises blood 

pressure. 

l	 Carbon monoxide from smoking 

reduces the amount of oxygen your 

blood can carry to the brain. 

l	 Cigarette smoke makes your blood 

thicker and more likely to clot. 

Your doctor can recommend programs 

and medications that may help you quit 

smoking. 

Obesity. Postmenopausal women with 

a waist size larger than 35 inches and a 

high triglyceride (treye-GLIH-suh-ryd),

or blood fat, level have 5 times the risk of 

having a stroke. 

40 The Healthy Woman: A Complete Guide for All Ages 
 

 

 

 

 

 

 

 

 

 

 

Diabetes. Diabetes is a disease in which 

the blood glucose, or sugar, level becomes 

too high. Diabetes damages blood vessels 

throughout the body, including the brain.

As a result, diabetes triples the risk of 

stroke. If the blood glucose level is high 

at the time of a stroke, brain damage 

is usually more severe than if the level 

is normal. Treating diabetes can delay 

the onset of blood vessel changes that 

increase stroke risk. 

For information on treating diabetes,

see the Type 2 Diabetes chapter on page 

69. 

Heavy alcohol use, illegal drug use. For 

women, more than one alcoholic drink 

per day raises stroke risk. Cocaine use is 

a common cause of hemorrhagic stroke 

in young people. Long-term marijuana 

smoking may also be a risk factor for 

stroke. 

Pregnancy. On rare occasions,

pregnancy can cause stroke, especially 

in the first few months after delivery.

Pregnancy increases blood pressure, and 

clots are more easily formed. 

Birth control pills or patch. Taking 

birth control pills or using the birth 

control patch is generally safe for young,

healthy women. With the pill, stroke risk 

is greater for women who also smoke 

cigarettes or who have migraines with 

aura (extreme headaches with a visual 

disturbance). 

With the patch, the stroke risk is greater 

for women who also smoke cigarettes.

Research has not yet shown whether 

women who have migraines with aura 

also have an increased risk of stroke 

when using the patch. If you get this 

type of headache, tell your doctor when 

discussing your birth control options. 

For an important warning on birth 

control pills and the patch and stroke 

and heart attack risks, see page 164 of 

the Reproductive Health chapter. For 

information on migraine headaches,

see page 357 of the Pain chapter. 

Menopausal hormone therapy.

Menopausal hormone therapy 

can increase stroke risk. If you use 

menopausal hormone therapy, you 

should take it at the lowest possible dose 

and for the shortest amount of time. 

Work with your doctor to come up with 

a plan that works best for you. 

For information on menopausal 

hormone therapy and the risks of 

stroke and heart attack, see page 28 of 

the Heart Disease chapter. 

Stroke 41 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Brain aneurysm. An aneurysm (ANyuh-riz-uhm) is a bulge that forms at 

a weak spot in an artery wall. Because 

most brain aneurysms look like a berry

hanging from a vine, they are often called 

“berry” aneurysms. Most aneurysms occur 

in arteries on the brain’s surface. You can 

have a brain aneurysm for years and not 

have any symptoms. But sometimes the 

aneurysm bursts, and blood flows into 

the space outside the brain. The result 

is a subarachnoid hemorrhage, a type 

of hemorrhagic stroke. (See page 38 for 

more information.) 

Symptoms of aneurysm may include: 

l	 pain above and behind the eye 

l	 numbness or weakness on one side of 

the face 

l	 problems seeing (such as double 

vision) 

Call your doctor if you have these 

symptoms. Large aneurysms can often be 

treated to prevent them from bursting. 

BrAIn AneurySm 

Preventing stroke 

At some point, 39 percent of women 

in the United States will develop

heart disease, stroke, or other diseases 

involving narrowing or hardening of the 

arteries. It is important for all women 

to pay attention to their risk factors 

for these diseases. The most important 

things you can do to reduce your chances 

of stroke are: 

l	 Treat high blood pressure. 

l	 Don’t smoke cigarettes. 

l	 Maintain an active lifestyle. 

If you have high blood pressure, you may

be able to lower it by: 

l	 losing weight if you are overweight or

obese 

l	 getting 30 minutes of moderate-


intensity physical activity on most 


days of the week
 

l	 limiting alcohol to one drink per day 

l	 eating foods that are good for your 

heart 

l	 reducing stress 

Your doctor may prescribe medicines to 

lower your blood pressure. It is important 

to take them as prescribed and not stop

them unless directed by your doctor. 

Some research suggests that healthy 

women older than age 65 may reduce 

their stroke risk by taking 80 mg aspirin,

or baby aspirin, daily. Aspirin makes 

blood clots less likely, which reduces the 

risk of an ischemic stroke. But aspir But aspirin 

can have serious side effects, such as 

bleeding in your stomach or intestines. If 

you’re thinking about taking aspirin, talk 

with your doctor first. 

42 The Healthy Woman: A Complete Guide for All Ages 
 

Choosing a hospital 

The hospital you go to can matter a 

great deal. You have a better chance of 

having a good outcome if you are taken 

to a certified stroke center at a hospital 

with the staff, equipment, and experience 

needed to treat stroke quickly and 

correctly. 

Stroke Centers 

To find a certified stroke center near 

you, see the Web sites of the Joint 

commission on the Accreditation of 

healthcare organizations and the national Stroke Association, listed in the 

resource section on page 48. 

As of August 2007, the following states 

have developed or are in the process 

of developing their own regulations for 

certifying hospitals as stroke centers: 

• Florida 

• maryland 

• massachusetts 

• new Jersey 

• new york 

• Texas 

If you live in these states, call your 

state health department to find out if 

there is a state-certified stroke center 

near you. 

Find the nearest certified stroke center,

and share the name and address with 

your family or caregivers. Tell them that 

if you have a stroke, you want to be taken 

to that hospital. Even if you live in a 

rural area, you might be able to be taken 

to a certified stroke center by helicopter. 

How is a stroke diagnosed? 

Once you get to the hospital, the 

following things will happen quickly: 

l	 A doctor or nurse will ask you or your 

companion about your symptoms and 

when they began. 

l	 You will be asked to perform several 

physical and mental tasks to see what 

parts of your brain might be affected 

by the stroke. 

l	 You will be given various tests to 

rule out other possible causes of your 

symptoms. 

If your doctor decides that you may have 

had a stroke, the next step will be to use 

one or more brain imaging techniques 

to see where the stroke is located. The 

two main techniques are computed 

tomography (tuh-MOG-ruh-fee) (CT) 

scan and magnetic resonance imaging 

(MRI). A CT scan is more commonly 

used because it is faster and more readily 

available in most hospitals. 

How is a stroke treated? 

If your brain scan shows that you’ve had 

an ischemic stroke, you may be given a 

shot of tissue plasminogen (plaz-MINuh-juhn) activator, or t-PA, into one of 

your veins. This drug travels in the blood 

to the brain and breaks up the clot.

t-PA must be given within 3 hours 

from the time your stroke started for it 

Stroke 43 
 

 

 

 

to work properly and safely. In fact, the 

sooner t-PA is given, the better it works.

That’s why it’s important for you to get 

to the hospital as quickly as possible. 

A new therapy for ischemic strokes is 

the Mechanical Embolus Removal for 

Cerebral Ischemia (MERCI) system.

This involves threading a thin wire 

through your blood vessels and into the 

artery in the brain that is blocked by a 

clot. The wire is used to pull the clot out 

of the body. The MERCI system can be 

used for up to 8 hours after the start of 

an ischemic stroke. 

There are fewer treatments for 

intracerebral hemorrhages (bleeding 

into the brain) than for ischemic strokes.

Usually, little can be done to stop the 

bleeding. But treatment usually involves 

trying to reduce pressure within the skull 

caused by bleeding with drugs or surgery.

Research suggests that a new drug,

called activated factor VII, can slow the 

bleeding if given within 4 hours of when 

it started. But this drug is still being 

tested and is not yet available for use in 

hospitals. 

If you have a subarachnoid hemorrhage 

because of a burst aneurysm, brain 

surgery will be needed to stop the 

bleeding from the aneurysm. 

Stroke Treatment Research 

much progress in stroke treatment has 

been made over the past decade. And 

many new treatments are in the final 

stages of testing and likely to be available for widespread use in the next 

few years. not long ago, doctors considered stroke an untreatable disease, 

but no more. The future of stroke 

treatment is looking brighter. 

Effects of a stroke 

After a stroke, you may have problems 

caused by damage to parts of your brain.

What problems you have depend on 

which parts of your brain were damaged.

Some of the problems that you may have 

after a stroke include: 

l	 Movement. You may have problems 

moving an arm, a leg, a part of your 

face, or the entire side of your body. You 

may also have problems swallowing. 

l	 Sensations. You may lose the ability 

to feel touch, pain, temperature, or position. Or you may experience pain or 

odd sensations of tingling or prickling. 

l	 Language. You may have problems 

speaking, writing, or understanding 

spoken or written words. 

l	 Thinking and memory. You may have 

a short attention span or have trouble 

remembering something you just 

learned. Or you may lose the ability to 

plan and carry out steps in a complex 

task. 

44 The Healthy Woman: A Complete Guide for All Ages 
l	 Emotions. The most common 

emotional problem faced by stroke 

survivors is depression. If you have 

depression, it’s important that you get 

treatment (see below for information 

on treating depression). Another common problem among stroke survivors 

is pseudobulbar (soo-doh-BUHL-bar) 

affect. If you have this condition, you 

might laugh or cry at inappropriate 

times. For instance, you might laugh 

at a sad story or cry for no reason.

Because a person with pseudobulbar 

affect may cry uncontrollably, the condition is often mistaken for depression. 

Therapies for stroke recovery 

In the first several months after a stroke,

some of the abilities that you lost may 

return on their own, but others may not.

The good news is that there are therapies 

that can help you recover functions or 

learn new ways of doing things. The 

more you work at these therapies, the 

more likely you will be to recover many 

of your abilities. Also, there seems to be 

no time limit for recovering. Research 

shows that some people who have had 

a stroke may keep recovering for years 

after the stroke. 

There are many different types of 

therapies used to help stroke patients 

lead independent lives. 

l	 Physical therapy helps you relearn 

simple movements, such as walking,

sitting, standing, and lying down. 

l	 Occupational therapy helps you relearn everyday activities, such as eating, drinking, dressing, and going to 

the bathroom. 

l	 Speech therapy helps you relearn how 

to speak and use language. Speech 

therapists can also help if you’re having trouble swallowing. 

l	 Psychotherapy helps you deal with 

your emotional problems. Depression,

for instance, can be treated with a 

combination of medicines and 

counseling. 

Stroke 45 
 

 

Research is leading to exciting new 

techniques to help stroke survivors. For 

instance, experts are developing robotic 

braces that fit over one or more joints 

and help you relearn movements. 

Most stroke survivors find that regaining 

lost abilities is hard work. It is normal 

to feel tired and discouraged at times 

because things that used to be easy are 

now difficult. The important thing is to 

notice the progress you make and take 

pride in each achievement. 

How family members can help 

If you are a family member of a stroke 

survivor, here are some things you can do: 

l	 Support your loved one’s efforts to 


help make decisions about their 


therapies.
 

l	 Encourage them to be as independent 

as possible. 

l	 Strive to be compassionate, patient,

positive, tolerant, and respectful. 

l	 Visit and talk with your loved one. Do 

things together, such as playing cards 

or a board game. 

l	 Participate in education offered for 

stroke survivors and their families. 

l	 Ask physical and occupational therapists how to outfit your home for the 

stroke survivor. For instance, you may 

need to install grab bars in the bathroom to help your loved one use the 

toilet, tub, or shower. 

l	 If your loved one has trouble speaking or understanding speech, ask the 

speech therapist how you can help. 

l	 To prevent bedsores, make sure your 

loved one does not sit or lie in the 

same position for long periods of time. 

l	 Take care of yourself by eating well,

getting enough rest, and taking time to 

do things that you enjoy. 

Perhaps most important, remember 

that caring family and friends can be 

a key factor in helping stroke survivors 

recover. n

46 The Healthy Woman: A Complete Guide for All Ages 
one Woman’s Story 

As an African

American woman, I 

was also at a higher 

risk for stroke. 

I

was 5 months pregnant and 36 years old at the time, casually talking on the phone 

when suddenly my right side became paralyzed and I lost my ability to speak. I began 

crawling on my hands and knees, motioning to my older daughter for help. Ten-year-old 

chelsea knew I was in serious trouble and called 911 right away. 

When I arrived at the hospital, I was paralyzed on the right side of my body and could 

not talk. my husband described me as being “in a vegetative state,” and the doctors discussed nursing home placement. I remained in the hospital for five days and was then 

transferred to another facility for rehabilitation. 

I was determined to regain function, 

and soon I was doing exercises to 

strengthen my hand and arms. I had 

to learn how to change a baby diaper 

and bathe a baby using only one hand. 

I progressed to walking just three days 

after being discharged home and by the 

seventh day, I had regained my speech. 

I had thought I was in good health. yet 

prior to getting pregnant, I sought an 

evaluation from my doctor for some 

frightening symptoms: my right arm 

would become numb for a short period 

of time or I would experience “pins and 

needles.” Sometimes I would have 

vision changes. Sometimes I could not speak. But these symptoms would last only a 

short time before everything would return to normal. I now know that I had been experiencing TIAs, which often serve as warning signs for an impending stroke. my original doctor did not order testing, and I was forced to change doctors to get the care I needed. my 

new doctor’s tests all came back negative and I received the ok to get pregnant. 

I learned that while stroke is uncommon in pregnancy, it does happen. I also had high 

blood pressure during the pregnancy, which is a risk factor for stroke. As an African American woman, I was also at a higher risk for stroke. 

My baby is fine. I have a healthy son. I can once again care for my family. After my recovery, my mission became to raise awareness of stroke symptoms, not just as a survivor 

and mom, but as mrs. new Jersey 2002—winner of the state beauty pageant! 

Cynthia 

New Jersey 

This story is provided courtesy of the Women’s heart Foundation. 

Stroke 47 
For More Information... 

Office on Women’s Health, HHS 

200 Independence Ave SW, room 712e
 

Washington, Dc 20201
 

Web site: www.womenshealth.gov/heart
 

www.womenshealth.gov/faq/stroke.htm
 

Phone number: (800) 994-9662, 

(888) 220-5446 TDD 

National Heart, Lung, and Blood Institut e 

Health Information Center, NIH 

Po Box 30105
 

Bethesda, mD 20824-0105
 

Web site: www.nhlbi.nih.gov 

www.hearttruth.gov 

Phone number: (301) 592-8573, 

(240) 629-3255 TTy 

National Institute of Neurological 

Disorders and Stroke, NIH 

Po Box 5801
 

Bethesda, mD 20824
 

Web site: www.ninds.nih.gov
 

Phone number: (800) 352-9424, 

(301) 468-5981 TTy 

American Stroke Association 

7272 Greenville Ave
 

Dallas, TX 75231
 

Web site: www.strokeassociation.org
 

Phone number: (888) 478-7653 

The Internet Stroke Center 

Washington university School of medicine
 

Department of neurology
 

660 S euclid, Box 8111
 

St Louis, mo 63110
 

Web site: www.strokecenter.org
 

National Stroke Association 

9707 e easter Ln, Building B
 

centennial, co 80112
 

Web site: www.stroke.org
 

Phone number: (800) 787-6537
 

To find a stroke center near you, visit: 

The Joint Commission 

www.qualitycheck.org 

48 The Healthy Woman: A Complete Guide for All Ages