Warning signs of a stroke in a woman

Knowing how to recognize stroke symptoms can save time, and time saved is brain saved

Much like heart attack symptoms, there are some common stroke symptoms that men and women share, but there are some subtle differences for women.

In women, stroke warning signs can be more subtle and may not appear serious enough to seek medical attention, putting the person experiencing them in grave danger. Emergency stroke treatment can mean the difference between life and death or full recovery and permanent disability.

Women are more likely than men to show generalized symptoms that may not correlate directly to a specific brain function. Women are more likely to experience symptoms such as fatigue, confusion or overall weakness rather than on just one side of the body, according to the American Heart Association.

Any sudden change should be noted, and, unfortunately, women are often busy caring for others and may overlook symptoms or dismiss them as minor.

“Women are prone to having unique symptoms for heart attack or stroke. Understanding these nuanced stroke warning signs can lead to faster treatment and better outcomes,” said Tamika M. Burrus, M.D., a neurologist focusing on stroke care at Norton Neuroscience Institute.

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Stroke symptoms more common in women

  • Confusion
  • Fatigue
  • Generalized weakness
  • Headache
  • Loss of consciousness
  • Mental status change such as irritability, anger, anxiety or depression

Women may dismiss symptoms such as generalized weakness as minor. Women who get migraine headaches may assume a sudden severe headache isn’t out of the ordinary for them. Additionally, women may be less likely to have some of the more obvious stroke symptoms such as difficulty talking, walking normally and keeping their balance.

Women affected by stroke more than men

Women have a higher risk than men to have a stroke and are more likely to have one at a younger age, according to a review of research, published in Journal of Stroke. In middle age, men tend to have more strokes than women.

There are two types of hemorrhagic strokes, and both are caused by a ruptured blood vessel. The more common type is due to elevated blood pressure. A more rare hemorrhagic stroke called a subarachnoid hemorrhage often is caused by a ruptured aneurysm. Aneurysms are also more common in women, and having decreased estrogen levels after menopause is suspected to increase risk of aneurysm.

A 2021 study in Canada, published in the journal Stroke, found that while women had an increased risk of stroke from a subarachnoid hemorrhage, they had lower risk of the other type of hemorrhagic stroke, ischemic stroke, and transient ischemic attack (sometimes called a ministroke).

In an ischemic stroke, blood flow to the brain is blocked by a blood clot that broke free and traveled to the brain or developed within the blood vessel. Without blood supply, brain cells start dying. The more brain cells that are lost, the greater the danger. That’s why neurologists often advise that “time saved is brain saved.”

Black and Hispanic women 70 or older have a significantly higher risk of stroke compared with white women.

Promptly recognizing that a stroke is underway can be critical to a successful recovery. Every minute counts when restoring blood flow to the brain.

Stroke treatment commonly includes an infusion of tissue plasminogen activator, known as tPA, a medicine that breaks up the blood clot blocking blood flow to the brain; or a minimally invasive procedure to mechanically remove the blood clot from the blood vessel.

Studies, including a 2022 review of published research, found that men and women were both likely to show stroke symptoms that suggested a specific area of the brain had been damaged: difficulty controlling motor skills and speaking, for example. Women, however, more often showed generalized symptoms that were less-obvious stroke warning signs.

Common stroke risk factors

  • High blood pressure (hypertension)
  • Diabetes
  • Atrial fibrillation
  • Dyslipidemia (high cholesterol or fat in the blood)
  • Migraine, which is more common in women
  • Obesity
  • Smoking

Stroke risk factors specific to women

  • Pregnancy (maternal stroke)
  • Preeclampsia and gestational high blood pressure (during pregnancy)
  • Peripartum cardiomyopathy (pregnancy-related heart failure)
  • Oral contraceptives
  • Hormone therapy

Symptoms of Stroke — BE FAST*

  • Balance — loss of balance, coordination or dizziness
  • Eyes — having trouble seeing or change in vision in one or both eyes
  • Face — uneven smile or face looks uneven, droopy or is numb
  • Arms — one arm drops when raising both arms; numbness or weakness in one arm
  • Speech — trouble speaking; slurred or difficult speech
  • Time — Note the time when symptoms start: Time lost equals brain lost.

*Adapted from Intermountain Healthcare. BE FAST was developed by Intermountain Healthcare, as an adaptation of the FAST model implemented by the American Stroke Association. Reproduced with permission from Intermountain Healthcare. Copyright 2011, Intermountain Healthcare.

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