ANN ARBOR, MI -What does it feel like to have a stroke? For some people, the ability to speak or walk disappears in a moment. For others, arms, legs and faces suddenly go numb. And for others, it's a rush of confusion or dizziness.

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Hopefully, such strange and sudden feelings would prompt most people to get help, get to an emergency room and get treatment right away. And the faster they act, the better their chances of surviving and escaping long-term disability: The only drug to treat stroke needs to be given in the first three hours after a “brain attack” starts.

But what if you had a stroke and your symptoms weren't typical? What if you felt sudden pain on one side of your body, or nearly had a blackout? Many people might shrug it off for a while, not even thinking it could be a stroke. Even if they seek treatment immediately, their description of their symptoms may not make a nurse or doctor suspect a stroke.

Women are more likely than men to have such non-typical stroke symptoms, according to previous research from a member of the University of Michigan Stroke Program that looked at data from past stroke patients in Texas.

Now, the U-M team is taking this issue to the next level, with a new project that thoroughly interviews every man and woman who comes to the U-M Emergency Department with any signs of stroke. By building a detailed picture of exactly what the patients felt, and how they described those feelings to others, the team hopes to find out more about gender differences in stroke.

Those differences could help explain things that have puzzled stroke specialists for years: why women often get to the emergency room too late for stroke treatment, and why they're more likely to die or be disabled by their stroke than men.

U-M research investigator Lynda Lisabeth, Ph.D., leads the study. She says that part of the problem may be a perception by women that stroke is a man's disease.

“I think a lot of women are unaware that cardiovascular disease, including stroke and heart attack, is their largest health risk,” she says, noting that stroke is the third leading cause of death and the top cause of disability in America. “It's important for women to understand that they're also at risk for having a stroke, and for both men and women to recognize the warning signs of stroke so they can call 911 immediately and get to the hospital quickly and in time for therapy.”

Lisabeth, a member of the U-M Health System's Stroke Program and the U-M Medical School's Department of Neurology, explains that while men have a higher risk of stroke over their lifetime, more women than men in the United States actually experience a stroke, because women on average live longer than men.

More women than men die from strokes, too. “Currently, women account for about 60 percent of U.S. stroke deaths each year,” she says.

The new U-M project is funded jointly by the Institute for Research on Women and Gender, the Office of the Vice President for Research, and the Department of Neurology at the University of Michigan.

It will make it possible for Lisabeth and her colleagues to collect more and better data about the symptoms that men and women feel when they have a stroke, and the things that happen after those symptoms start.

In addition to documenting the classic stroke symptoms of sudden speech, vision, movement and thinking problems, the researchers will also ask patients about a range of symptoms and sensations not usually associated with stroke, to see how often these occur. And, they'll ask permission to look at individual patients' records and see how long it took them to arrive at the hospital, and how they arrived.

“If women are experiencing non-traditional stroke symptoms, they may be unaware that they're having a stroke, and this may result in a delay in seeking care and getting to the hospital,” says Lisabeth. “Once at the hospital, it could actually result in a delay in getting acute stroke therapy.”

That therapy, called tPA, has been proven to save lives and prevent long-term disability. It's used in stroke patients whose stroke is caused by a blocked blood vessel in the brain – which accounts for the vast majority of strokes in the United States. But tPA is only effective at breaking up those blood clots and restoring blood flow to the brain if it's given within three hours of the start of symptoms.

Many patients who could have been saved from death or lifelong paralysis by tPA don't get it because they don't get to the hospital in time, or don't get diagnosed quickly once they're there.

The U-M team is careful to note that they don't know yet whether non-traditional stroke symptoms play a significant role in delaying patients – that's why they're doing the new study.

In the meantime, they hope that everyone will take a moment to think about their own personal risk of stroke, to learn about the usual signs of stroke, and to talk to their families and co-workers about what to do if someone experiences any sudden unexplained symptoms.

And of course, says Lisabeth, there are steps everyone can take to reduce their risk of stroke now or down the road.

For instance, she cites stopping smoking, losing weight, exercising, cutting back on excessive alcohol use, and reducing blood pressure and cholesterol levels if they're high. People with high blood pressure, diabetes, irregular heartbeats, heart disease or a history of heart attacks or “mini strokes” called transient ischemic attacks or TIAs should be especially careful.

“There are also a number of factors about yourself that you can't change that can put you at increased risk for stroke, such as your age, your gender, your race or ethnicity, and your family history of stroke,” says Lisabeth. But no matter what your situation, you can still take preventive steps – and learn what to do if a stroke strikes you or someone around you.

“Stroke is a very serious disease in our country, with about 700,000 people experiencing a stroke each year,” she says. Studies like the U-M effort will help reveal more about how those 700,000 people feel during and after their stroke – and perhaps help make things better for the people who have strokes in the future.

Facts about stroke, and gender differences:

• Stroke is the nation's third most common cause of death. It's also the top cause of disability.
• Although men have a higher lifetime risk of stroke, women live longer than men. So, more women than men suffer strokes and die from strokes.
• Strokes are interruptions of blood flow to or within the brain. Most often, they're caused by blood clots that get stuck in a blood vessel in the brain – these are called ischemic strokes. Some strokes come from a leaky blood vessel in the brain; these are hemorrhagic strokes.
• Strokes are “brain attacks” – they starve part of the brain of oxygen. That's what causes the immediate symptoms. If the blockage or leak isn't treated, it can cause severe long-term damage that can rob a person of some or all of their ability to speak, think, or walk.
• Different people will have different symptoms from strokes, depending on where in the brain the blood clot or blood leak occurs. For instance, a clot in the area of the brain that controls language may cause a person to lose their ability to speak clearly or understand others.
• The main characteristic of a stroke is the sudden onset of symptoms. Typical symptoms include numbness or lack of coordination, speech and thinking problems, problems understanding what other people are saying, loss of vision in one or both eyes, and inability to walk. Non-typical symptoms include pain and lowered levels of consciousness.
• Women are more likely than men to report non-typical stroke symptoms, according to a study published by researchers from the University of Michigan and the University of Texas.
• Women also wait longer than men to get to the emergency room after a stroke, and to be seen by a doctor once they get to the ER.
• People who get to the hospital within 3 hours of the start of their stroke may be able to get tPA, a drug that busts up clots and can save a life or prevent permanent disability.
• People at high risk of stroke include those with high blood pressure, heart disease, heart rhythm problems, diabetes, obesity, high cholesterol, tobacco addiction and high alcohol consumption. Hispanics and African Americans have a higher risk than whites and Asians. People with a family or personal history of strokes or “mini strokes” have a higher risk.
• Weight loss, exercise, stopping smoking, cutting back on drinking and controlling blood pressure and cholesterol can all help a person reduce his or her later risk of stroke.

Find out more on the web at:

U-M Health Topics A to Z: Stroke

U-M Stroke Program

American Stroke Association

National Institute of Neurological Diseases & Stroke: Stroke information page

Written by Kara Gavin

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