Women at risk for rare strokeBy Betsy Lee
Special to the Caller-Times
Sunday, August 3, 2008
Gloria Gonzales, a 68-year-old stroke survivor, didn't know that her family history increased her risk of stroke.
However, family history, though an important factor, may pale in comparison to new research suggesting that Gonzales is more at risk for a certain type of stroke simply because of her gender and race.
Subarachnoid hemorrhage, an uncommon yet deadly type of stroke, is more likely to strike women and Mexican-Americans, according to findings from an ongoing analysis of Corpus Christi residents.
The study from the University of Michigan found that women of any ethnicity have a 74 percent greater chance of experiencing this type of stroke than men. Mexican-Americans of both genders have a 67 percent greater chance of suffering this type of stroke than non-Hispanic whites. The study was published in the June 11 online edition of Neurology.
All strokes cause the death of some brain tissue because of lack of oxygen, but in the case of subarachnoid hemorrhage, bleeding in the brain causes the tissue death. The bleeding can be triggered by a ruptured aneurysm or head injury. And though this stroke type is uncommon, representing only about 5 percent of the more than 700,000 strokes that occur annually in the U.S., the condition kills nearly one-third of its victims.
"The study shows a great disparity," said Dr. Lewis Morgenstern, senior author of the study. "In Corpus Christi, we are among the first to show that Mexican-Americans in particular are at a higher risk."
The study, however, offers little explanation why this type of stroke attacks more women and Mexican-Americans. Researchers examined blood pressure, age, excessive alcohol use, smoking and whether a patient had health insurance as possible reasons for the disparity. According to Morgenstern, none of these factors contributed to the gap.
One possibility, though Morgenstern has no data to suggest it, might be access to quality health care and health information. Though the study ruled out health insurance status as a factor, it did not take into account the quality of that insurance or lifestyle differences that might make women and Mexican-Americans less likely to visit a doctor.
Dr. Frank Bonikowski, a local neurologist, said in his experience, these factors are significant.
Prior to her stroke 10 years ago, Gonzales said she didn't have time to visit the doctor. Her headaches and neck pain seemed minor compared with caring for her disabled brother, ailing mother and 17-year-old son. Gonzales also had a strong family history of stroke, but was unaware that this might mean she had a higher risk herself.
For Gonzales, access to quality health insurance has been a barrier to seeking care. Physicians told Gonzales that she was at risk for another stroke and should have her neck veins examined annually. But Gonzales said she has had them checked only once since her stroke.
"Insurance will only pay if I'm having symptoms," she said.
Both Bonikowski and Morgenstern said genetics might answer the "why" question. Morgenstern hopes to uncover more data in the next few years. Participants in the ongoing study are providing a sample of blood, from which researchers are collecting a full DNA profile.
But even without the "why" question answered, researchers say the latest research could have far-reaching effects.
"As the years go by, I think that the impact is going to be felt not only in Nueces County, but all over the country," said Nelda Garcia, Corpus Christi field director for the study. "It greatly raises awareness, helping physicians and the public realize who is more at risk for this particular type of stroke."
The value lies in possible changes in physician practices. Subarachnoid hemorrhage can be difficult to diagnose, according to Bonikowski, sometimes requiring expensive and time-consuming tests.
"It's easier to miss this type of stroke," Bonikowski said. "But now we'll have more data available to indicate that it might be a potential in these at-risk groups."
Garcia also hopes the public will become more aware of stroke risk factors and the symptoms associated with subarachnoid hemorrhage.
These new findings are the latest data to emerge from the Brain Attack Surveillance in Corpus Christi project. This ongoing project, which began in 2000, studies the brain health of the Corpus Christi population. Corpus Christi was selected because of the city's diversity and largely Hispanic population, which reflects that of the changing U.S. population.
Research assistants visit local hospitals and clinics daily to collect stroke and brain attack data. And neurologists such as Bonikowski review the information before it is sent to the University of Michigan for analysis. The project recently received another five-year grant to continue its studies.
"As the years go by, I think that the impact is going to be felt not only in Nueces County, but all over the country. It greatly raises awareness, helping physicians and the public realize who is more at risk for this particular type of stroke."
Nelda Garcia, Corpus Christi field director for the study
Subarachnoid Hemorrhage
Risk factors
High blood pressure
Smoking
Strong family history of stroke or aneurysms
History of polycystic kidney disease
History of fibromuscular dysplasia and other connective tissue disorders
Disorders associated with aneurysm or weakened blood vessels
Symptoms
Severe headache that starts suddenly and is worse at the back of the head. It may start after an odd "popping or snapping" sensation. Patients commonly describe the headache as "the worst headache of their lives."
Stiff neck
Decreased consciousness and alertness
Loss of movement or sensation in part or all of the body
Nausea and vomiting
Sensitivity to light
Vision problems, such as blind spots or temporary vision loss
Information:
www.nlm.nih.gov/medlineplus/ency/article/000701.htmSource: The National Institutes of Health, Medical Encyclopedia
http://www.caller.com/news/2008/aug/03/women-at-risk-for-rare-stroke/
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