Some risk factors for stroke apply only to women.
Primary among these are pregnancy, childbirth, and
menopause. These risk factors are tied to hormonal
fluctuations and changes that affect a woman in
different stages of life. Research in the past few
decades has shown that high-dose oral contraceptives,
the kind used in the 1960s and 1970s, can increase
the risk of stroke in women. Fortunately, oral
contraceptives with high doses of estrogen are no
longer used and have been replaced with safer and
more effective oral contraceptives with lower doses
of estrogen. Some studies have shown the newer low-dose
oral contraceptives may not significantly increase
the risk of stroke in women.
Other studies have demonstrated that pregnancy
and childbirth can put a woman at an increased risk
for stroke. Pregnancy increases the risk of stroke
as much as three to 13 times. Of course, the risk of
stroke in young women of childbearing years is very
small to begin with, so a moderate increase in risk
during pregnancy is still a relatively small risk.
Pregnancy and childbirth cause strokes in
approximately eight in 100,000 women. Unfortunately,
25 percent of strokes during pregnancy end in death,
and hemorrhagic strokes, although rare, are still
the leading cause of maternal death in the United
States. Subarachnoid hemorrhage, in particular,
causes one to five maternal deaths per 10,000
pregnancies.
A study sponsored by the NINDS showed that the
risk of stroke during pregnancy is greatest in the
post-partum period - the 6 weeks following
childbirth. The risk of ischemic stroke after
pregnancy is about nine times higher and the risk of
hemorrhagic stroke is more than 28 times higher for
post-partum women than for women who are not
pregnant or post-partum. The cause is unknown.
In the same way that the hormonal changes during
pregnancy and childbirth are associated with
increased risk of stroke, hormonal changes at the
end of the childbearing years can increase the risk
of stroke. Several studies have shown that
menopause, the end of a woman's reproductive ability
marked by the termination of her menstrual cycle,
can increase a woman's risk of stroke. Fortunately,
some studies have suggested that hormone replacement
therapy can reduce some of the effects of menopause
and decrease stroke risk. Currently, the NINDS is
sponsoring the Women's Estrogen for Stroke Trial
(WEST), a randomized, placebo-controlled,
double-blind trial, to determine whether estrogen
therapy can reduce the risk of death or recurrent
stroke in postmenopausal women who have a history of
a recent TIA or non-disabling stroke. The mechanism
by which estrogen can prove beneficial to
postmenopausal women could include its role in
cholesterol control. Studies have shown that
estrogen acts to increase levels of HDL while
decreasing LDL levels.
The young have several risk factors unique to them.
Young people seem to suffer from hemorrhagic strokes
more than ischemic strokes, a significant difference
from older age groups where ischemic strokes make up
the majority of stroke cases. Hemorrhagic strokes
represent 20 percent of all strokes in the United
States and young people account for many of these.
Clinicians often separate the "young" into two
categories: those younger than 15 years of age, and
those 15 to 44 years of age. People 15 to 44 years
of age are generally considered young adults and
have many of the risk factors mentioned above, such
as drug use, alcohol abuse, pregnancy, head and neck
injuries, heart disease or heart malformations, and
infections. Some other causes of stroke in the young
are linked to genetic diseases.
Medical complications that can lead to stroke in
children include intracranial infection, brain
injury, vascular malformations such as moyamoya
syndrome, occlusive vascular disease, and genetic
disorders such as sickle cell anemia, tuberous
sclerosis, and Marfan's syndrome.
The symptoms of stroke in children are different
from those in adults and young adults. A child
experiencing a stroke may have seizures, a sudden
loss of speech, a loss of expressive language
(including body language and gestures), hemiparesis
(weakness on one side of the body), hemiplegia
(paralysis on one side of the body), dysarthria
(impairment of speech), convulsions, headache, or
fever. It is a medical emergency when a child shows
any of these symptoms.
In children with stroke the underlying conditions
that led to the stroke should be determined and
managed to prevent future strokes. For example, a
recent clinical study sponsored by the National
Heart, Lung, and Blood Institute found that giving
blood transfusions to young children with sickle
cell anemia greatly reduces the risk of stroke. The
Institute even suggests attempting to prevent stroke
in high-risk children by giving them blood
transfusions before they experience a stroke.
Most children who experience a stroke will do
better than most adults after treatment and
rehabilitation. This is due in part to the immature
brain's great plasticity, the ability to adapt to
deficits and injury. Children who experience
seizures along with stroke do not recover as well as
children who do not have seizures. Some children may
experience residual hemiplegia, though most will
eventually learn how to walk.
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