1. Women and Stroke Women’s Health Conference Kirsten Krummel-McCracken, RN, MSN, CNRN, SCRN

2. Introduction While driving home from work, Stacey Yepes, 49, could sense she was beginning to have a stroke. To ensure others could see what was happening to her, she pulled over, took out her smartphone and began recording. woman having a stroke

3. US Stroke Statistics Every year 795,000 Americans suffer a new or recurrent stroke –Every 40 seconds someone has a stroke 5 th leading cause of death overall/for men –Stroke kills more than 137,000 people per year –Every 4 minutes someone dies from a stroke 11 million silent infarcts occur each year Stroke is the #1 cause of adult disability In 2010, Americans spent about $74 billion on stroke-related medical expenses and disability

4. Women and Stroke Each year about 55,000 more women than men have strokes –The average life expectancy of women is longer than men and the highest rate of stroke is in older age groups Stroke is the 3 rd leading cause of death in women –In 2011, strokes cause the death of 76,597 females in the US An estimated 3.6 million female stroke survivors are alive today

5. Stroke: Blood Flow to Your Brain Stops Ischemic stroke accounts for about 85% of all strokes –15-50% of stroke patients report experiencing TIA prior to their stroke About 15% of strokes are hemorrhagic –Hemorrhages cause 75% of inpatient stroke deaths

6. CT Scans of Strokes Ischemic StrokeHemorrhagic Stroke

7. Transient Ischemic Attack (TIA) Same pathophysiology as stroke –Except the symptoms go away –Many last less than 30 minutes Modern imaging technology shows that symptoms as short as 1 hour may cause damage Same risk factors as a stroke Same work-up as stroke The first 72 hours are critical! –High risk for a major stroke It’s not a “mini-stroke” … It’s a maxi-event! Seek medical attention… even if the symptoms go away…

8. Symptoms of Stroke One-sided weakness –One arm or leg or both –Facial droop Sensory change Language change Visual changes Gait disturbance Dizziness Worst headache of your life Decline in consciousness Rapid Onset Of:

9. Lobes of the Brain Frontal lobe: Personality, emotions, inhibition Parietal lobe: Light touch, pain, temperature Temporal lobe: Memory, language understanding Occipital lobe: Vision Cerebellum: Balance, coordination Brain stem: Breathing, swallowing

10. There’s Treatment if You Act FAST! What do you do when you think someone is having a stroke?

11. Emergency Treatment Spot a stroke FAST! Call 911 –Don’t wait for it to go away Emergency Room –Rapid Brain Attack algorithm CT scan Labs Medical history –Determine if tPA candidate Clot-Busting Therapy –tPA, Alteplase, Actvase –Ischemic strokes only –Timing is critical! 3 hours from symptom onset Goal < 60 minutes “Door-to-Needle”

12. Proportion of patients with recurrent stroke in 5 years after first stroke. Mozaffarian D et al. Circulation. 2015;131:e29-e322

13. Proportion of patients dead within 5 years after first stroke. Mozaffarian D et al. Circulation. 2015;131:e29-e322

14. Know Your Risk Factors for Stroke Things we can’t change –Age –Gender –Genetics Ethnicity Family history –Past medical history Things we can change –Disease management –Environmental exposure –Lifestyle or behaviors Non-Modifiable vs. Modifiable

15. Lowering Your Risk Modifiable Risk Factors –Hypertension –Diabetes –High Cholesterol or LDL –Sleep Apnea –Obesity Can cause all of the above –Atrial Fibrillation –Smoking –Excessive Alcohol Intake –Illicit Drugs Work with your Primary Care Provider

16. Risk Factors Specific to Women Menopause –Early (<42 yo) 2x higher risk than all other women –Estrogen + progesterone Increases IS risk by 44% Pregnancy –2.4 times higher than non-pregnant –First 6 weeks post-partum 8 fold risk Preeclampsia Contraception –Pill + smoking Other “female” risk factors –Migraines –Autoimmune diseases Gender differences in risk factors can be related to the reproductive system

17. Heart Healthy = Brain Healthy Walk, Walk, Walk!!!

18. Kids Have Strokes Too! Incidence –Under 15 years old 6 strokes per 100,000 children per year Presentation –Same symptoms as adults –More likely to have a seizure at onset Risk Factors –Birth defects –Prematurity –Infection Meningitis & Encephalitis –Trauma –Blood disorders Sickle Cell

19. Keep Your Brain Strong! Summary –Prevent Stroke Take your meds as directed Eat healthy foods Exercise everyday Don’t smoke –Act FAST! Call 911

20. Questions? Thank you!