In the popular imagination, strokes happen at senior centers, not motorcycle rallies. They're certainly not supposed to befall a woman like Sandra Thornburg.
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In 2001, she was a vibrant, 43-year-old exercise fanatic attending nursing school in Phoenix. Newly divorced, she embraced singlehood by meeting new people and trying new things, Harley-Davidson bikes included.
Thornburg was sleeping after a day's ride in northern Arizona when a sharp pain knifed through her head. She tried to get up, but her left side didn't work and her mind was in a fog. "I had no idea what was going on," she says. When she got to the hospital, her prognosis was grim.
"They told my family I wasn't going to survive," she says.
A decade ago, it took a massive effort by researchers and others to alert women — and doctors — to the long-overlooked risk of female heart attacks. Now, experts say, it's time to turn the spotlight on another lurking danger: the devastation that can occur from a stroke, or "brain attack."
More than 100,000 American women under age 65 suffer strokes every year, according to the American Stroke Association. That eclipses the 83,000 women in that age range who have heart attacks. Even more surprising: The risk surges between ages 45 and 54. In those years, women are more than twice as likely as men to have strokes. And at every age, strokes are harder on women — they're more likely than men to wind up physically and mentally impaired.
"We all learned in medical school that strokes and heart attacks are male problems," says Lewis Morgenstern, MD, director of the stroke program at the University of Michigan Medical School. "The reality is far different."
Those grim statistics reflect plenty of missed opportunities: Doctors often overlook chances to prevent strokes in women, especially those that hit at relatively young ages. If a woman does have a stroke, studies show that her physicians will almost certainly take longer to diagnose it than they would for a man. And even after her problem is recognized, she's less likely to get all the treatments and tests that can improve her chances of a successful recovery.
But it doesn't have to be that way. Here is what's behind the gender bias — and the facts that can save your life.
Thornburg felt perfectly healthy before her stroke, but a simple medical exam would have shown the ingredients for a catastrophe. "If the right risk factors are in place, a woman can have a stroke in her 40s instead of her 70s," says David Katz, MD, MPH, director of the Prevention Research Center at Yale University. "But if she takes care of herself, the chances are very remote."
Thornburg's vulnerability started with high blood pressure and high cholesterol — each encourages a buildup of arterial plaque, the raw material for a stroke-inducing clot. (Most strokes occur when a clot chokes off blood to the brain; another type, caused by a burst blood vessel in the brain, is rare.) Studies show that women nearly halve their risk of stroke simply by bringing high blood pressure under control. Lowering high cholesterol is just as helpful. But doctors are less likely to check women's cholesterol than men's, and if it's high, they treat it less aggressively. As for hypertension, it's undertreated in men and women.
Thornburg's bad numbers were particularly unfortunate because she was on birth control pills. Most healthy women in their 30s and 40s can take the Pill without worry as long as they don't smoke, says Cheryl Bushnell, MD, an associate professor of neurology at Wake Forest University. But even nonsmokers like Thornburg should steer clear of oral contraceptives if they already have a couple of stroke risk factors, such as high cholesterol, hypertension, obesity or diabetes.
Where docs fall short
Speed is critical in treating a stroke: There's just a 3-hour window to use a clot-busting drug called tissue plasminogen activator, or tPA, which greatly improves a victim's chances of avoiding death or lifelong disability. But gender differences in stroke symptoms can throw doctors off track. Delays in diagnosis help explain why a study of more than 2,000 patients in Michigan found that women were only about half as likely as men to get tPA.
Lori Manning knows what it's like to be on the wrong side of the gender divide. A 35-year-old multitasking machine before a stroke suddenly left her confused and capable of saying only, "I'm okay," Manning was a prime example of women who stray from classic stroke symptoms. Several supposedly telltale signs — loss of balance and sudden weakness, numbness, or paralysis on one side of the body — are less common in women than in men, a 2002 study showed. At the same time, women are more likely to suffer pain, confusion or loss of consciousness — less familiar signs of stroke.
The symptom gap isn't the only thing that slows diagnosis. On average, women get to the emergency room an hour later than men when a stroke hits, partly because stroke isn't on their mental checklist of ER-worthy dangers. And when they reach the hospital, it takes women about an hour longer to be examined by a neurologist.
In Manning's case, doctors lost time checking for meningitis. They diagnosed the stroke after several hours — too late for tPA. Manning has spent the past 5 years relearning how to talk and read, and only recently started to volunteer for the American Heart Association.
Even after diagnosis and treatment, women continue to get short shrift. In 2005, Morgenstern reported that female stroke patients often miss out on two critical tests that can help prevent further problems: They get imaging of the carotid arteries in the neck, which feed the brain, only 57 percent as often as men do, and an echocardiograph, which gives a detailed view of the heart, 64 percent as often (abnormalities in heart rhythm can increase the risk of stroke). One in seven stroke patients has a second stroke within a year, Morgenstern says, and these tests are crucial in preventing that blow.
Thornburg was lucky: Her doctors eventually realized she had a clotting disorder and put her on a blood thinner to prevent a recurrence. Every step still takes concentration — but a few years ago, she was able to walk 15 miles in an American Stroke Association marathon.
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