Time is not just money, it’s fundamentally crucial for the brain, particularly in instances of stroke. Each minute that ticks by signals the loss of approximately 1.9 million neurons out of the 86 billion housed in the human brain, according to American Heart Association research. This devastating domino effect highlights the vital need for immediate action when signs of stroke become evident.
“The brain is incredibly susceptible to injury,” explains Dr. Eliza Miller, a neurologist at the NewYork-Presbyterian/Columbia University Irving Medical Center. It’s this ticking time bomb scenario that has led to the development of the ‘BE-FAST’ mnemonic aiding in swift identification of a stroke’s key indicators. The acronym stands for balance loss, eyesight changes, face drooping, arm weakness, speech difficulty and time to call 911.
But even ‘BE-FAST’ is not entirely flawless. Emerging research has identified that this may not capture the full scope of diverse stroke experiences, with women, in particular, often presenting with less commonly recognized symptoms. Unusual and overlooked symptoms are contributing to stroke’s alarming status as the fifth leading cause of death in women, explains Dr. Hera Kamdar, an assistant professor of neurology at The Ohio University Wexner Medical Center.
Kamdar notes that women, beyond the ‘BE-FAST’ symptoms, may display severe headaches, generalized weakness and fatigue, shortness of breath and chest pains, nausea and vomiting, brain fog, and even hiccups. These less obvious manifestations appear suddenly and may be mistakenly attributed to other health problems. Furthermore, these symptoms might not display the commonly recognized pattern of one-sided weakness.
While these symptoms may seem random, their appearance during a stroke could indicate considerable damage to areas of the brain such as the medulla oblongata, involved in controlling breathing, and the supratentorial cortex, which governs movement control. Take hiccups for example, while not every hiccup spells stroke, they become concerning if they are hurting the throat or are in combination with other symptoms like vomiting.
Interestingly, there are noticeable differences in the way strokes present in women compared to men. Emerging theories propose the critical role of hormones in this differentiation. Estrogen, the predominant female reproductive hormone in the body, stands out as a significant player. It has been observed to have anti-inflammatory effects that potentially shield against brain injury and promote increased blood flow in the internal carotid artery, which supplies blood to the brain.
Nevertheless, it’s crucial to note that these protective benefits apply only to naturally-occurring estrogen. Synthetic estrogen, whether ingested through birth control or hormone replacement therapy, can ironically hike the risk of stroke. Yet, even in such scenarios, the elevated risk remains small, quips Miller.
The risk of stroke also increases with age, partly due to the estrogen levels droping during menopause. A longer lifespan in women as compared to men also increases the opportunity for a stroke occurrence. Pregnancy, too, increases the risk of stroke, primarily due to conditions like preeclampsia, which raises blood pressure, and the inherently higher risk of blood clots during delivery.
Reaction time is the pivot on which stroke recovery hinges, underscore both neurologists. Miller implores everyone to err on the side of caution and call 911 immediately irrespective of doubts. “I’d rather a person come into the emergency room and turn out to be completely fine than not come at all and we miss the chance to treat the stroke,” she urges.
