Here are the warning signs we all need to know.

By Sara Gaynes Levy
Updated: Mar 06, 2019 @ 12:21 pm
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Actor Luke Perry’s death on Monday was shocking, for fans and his costars alike. Perry was only 52, and his rep confirmed he died as the result of a “massive” stroke. Strokes are terrifying for exactly this reason: they can come on very suddenly and are extremely serious — Perry died just five days after being hospitalized. And while strokes are the fifth leading cause of death for men, they are the third leading cause of death for women. So it’s especially crucial as women that we understand what a stroke looks like, whether we are at risk for one, and what to do if we suspect we or someone we know is having one.

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Strokes occur when blood flow to the brain is cut off. They can happen to anyone at any time, but “the major risk factors include high blood pressure, high cholesterol, and diabetes,” explains Sarah Song, MD, a fellow of the American Academy of Neurology and the founder of the Comprehensive Women’s Stroke Clinic at Rush University Medical Center in Chicago. Other risk factors are family history, advanced age, experiencing migraines, being a smoker, genetic predisposition to blood clots, and race (African-Americans are the most likely to experience a stroke).

Unfortunately, says Dr. Song, women also have a specific set of extra risk factors: taking hormonal birth control (which makes you more prone to blood clots) and pregnancy. “Pregnancy is considered a high risk time because your body is pumping out a lot more blood to the fetus. More blood means a higher risk of clotting,” she says. Pregnancy also can lead to a predisposition to bleeding strokes, where either a brain aneurysm bursts or a weakened blood vessel begins leaking. The risk of stroke when taking hormonal birth control is much more of a factor if you are also a smoker, says Dr. Song.

“Historically, yes, hormone replacement and oral birth control has shown increased stroke risk,” she explains. “But the newer ones are much safer than the older ones, and in women who don’t have other risk factors — like smoking, hypertension — they are considered to be safe and to confer minimal risk. But, in women with other vascular risk factors, and migraines, they can be a risk factor for stroke.” The newer formulations, with lower doses of estrogen and progestin, are much safer, Dr. Song explains.

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As far as the warning signs, or stroke symptoms, it’s important to note that strokes don’t really present differently in men and women, despite rumors to the contrary. “Generally the signs of stroke are sudden, and one-sided. We use the acronym FAST to describe face, arm, speech, and time,” Dr. Song says. “Face refers to when you look in the mirror and smile, it’s asymmetric because one side of your mouth is drooping; arm means when you raise both arms, you have trouble keeping one side raised due to weakness, or one arm is tingling or feels numb (this can also happen in your legs, or both),” she says. "Speech refers to difficulty producing speech, garbled speech, slurred speech, or not comprehending other people’s speech. Finally, time refers to the emergency nature of getting assessed and being treated,” Dr. Song explains. Time is perhaps the most important of the four elements, as the most effective stroke treatment (a drug known as IV TPA, or Alteplase) really only works if administered within four and a half hours of the stroke itself.

VIDEO: Stroke Symptoms to Look Out For

To get ahead of this time crunch, Dr. Song adds a few more stroke signs to be aware of. “For my patients I also add BE FAST to the acronym: B stands for balance, meaning sudden onset of vertigo, or room-spinning, and trouble walking or difficulty with coordination, and E stands for eyes, meaning sudden double vision, crossed vision, or loss of vision in one eye, or both eyes, or part of one or both eyes.” If you or someone you know is experiencing numbness or weakness, especially on one side of the body, that’s a key warning sign of a stroke and it’s important to act fast. As Dr. Song’s tips suggest, you could ask a person to smile if you suspect they are experiencing a stroke. You could also ask a person to repeat something back to you, to be sure they’re able to speak properly — another immediate tell.

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A healthy diet and exercise can reduce the risk of experiencing stroke, but Dr. Song says the most important thing for women is taking strokes seriously and not trying to tough it out if you experience any warning signs. “Stroke is a treatable disease and should be viewed as an emergency,” she says. “Many times we think ‘I’ll just take a nap and see if it gets better’ or ‘maybe I’ll wait until the morning and call my doctor then.’  I ask you to please, instead, call 911.” This is true whether it’s you or someone you know experiencing symptoms — these require immediate medical attention. “Women are the caretakers of others,” says Dr. Song. “Talk to your friends and family about what stroke looks like. And most of all, when you see a stroke or think someone is having a stroke, call 911.”

Ed. note: This article has been updated to reflect the time frame in which stroke treatment is most effective; it's four and a half hours, not four hours.

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