Spokane neurologist Dr. Madeleine Geraghty isnt thrilled with the view directly outside her second-floor office window at Rockwood Clinics main building near downtown. There, below, is a smoking area for patients and staff.


Knowing that smoking, along with high blood pressure, are the two highest risk factors for stroke, shes thought about placing an electronic ticker display in her window that would flash what she says are some scary statistics about strokes.


Among them are some frightening statistics for women, who, by a three-to-two margin, are more likely to die from a stroke than men. Women also stay in hospitals after stroke-related incidents longer than men, and, as a whole, are more disabled by strokes than their male counterparts, Geraghty says.


Whats more, women are historically much slower in reporting symptoms of the disease, for which fast medical treatment is critical, says Sherry Nash, neuroscience/stroke coordinator at Sacred Heart Medical Center.


Women traditionally are the caregivers who put their own health issues last, says Nash. We often see women who saw signs a week earlier, but the signs went away in a few minutes, and they didnt seek treatment. With their husbands, they would have insisted they go immediately to the emergency room.


Geraghty and Nash agree not only that the general public is ill informed about differences between women and men when it comes to strokes, but those in the medical profession also seem to have the same lack of information.


The differences between women and men in regards to many health issues are just beginning to be understood, Geraghty says. She says thats also true of strokes.


Most of the medical community doesnt understand how men and women differ about strokes, she says.


Nash takes the issue a step further, asserting that many physicians may not treat the symptoms of stroke as aggressively for women as they do for men. I think thats a culture thing that needs to change, she says.


Strokes come in many varieties and degrees of severity, but 80 percent of them can be defined roughly by a blood clot blocking the supply of blood to the brain, says Geraghty. The other 20 percent involve a hemorrhage of blood vessels in the brain, she says. Aneurysms, or a sac caused by an enlargement of a weakened wall of a cranial artery or vein, are the most common cause of hemorrhaging strokes, which are more severe and have a higher mortality rate.


When blood flow is blocked from reaching a part of the brain that controls a particular bodily function, the patient could lose control of that functionand even dieif the blockage isnt treated quickly.


Onset older than for men


Women who suffer strokes, on average, have their first stroke at age 74, compared with men, whose average age for a first stroke is 68. Women are more likely to have strokes triggered by heart complications, while men are more likely to have cholesterol-related strokes, Geraghty says.


Women with medium-range cholesterol buildup in their arteries often can lower that level with the help of medications such as aspirin, while men with medium-range cholesterol buildup are more likely to require surgery.


In that surgery, the artery is sliced open and a tiny surgical device with a whirring blade is inserted into blood vessels to scrape away the cholesterol, she says.


Stroke is a big killer of women. One of every 2.5 women dies of either heart disease or stroke, Geraghty says, compared with about one in 30 who die of breast cancer.


She says that pregnant women are more at risk for stroke than the general female population because of blood clotting issues, as are women who take hormone therapy.


Women of African American heritage have the highest death rate of stroke victims, says Geraghty. She doesnt know the precise reason, but suggests that poor access to health care and some unknown factors regarding ethnicity could be involved.


We do know that African Americans have a much higher rate of uncontrolled blood pressure and diabetes, she says.


With stroke being the third leading cause of death in America behind heart disease and cancer, Geraghty says, I have a deep abiding interest in stopping strokes before they start.


In addition to not smoking and keeping blood pressure under control, she says the common-sense approach of exercising, even moderately, and eating less fatty foods and more fruits and vegetables helps deter strokes.


What is good for the heart is good for stroke prevention, says Geraghty.


She says many patients say theyre unwilling to give up their accustomed lifestylethat they want to keep living the way theyve been living and are willing to take the risks that createsbut she offers them this counterargument:


While heart attacks often kill, strokes often disable, leaving the victim horribly disabled, Geraghty says.


Get help fast


Although 60 percent to 80 percent of all strokes occur with no warning signs, anyone who notices a potential symptom of stroke should seek medical assistance immediately, Geraghty says.


Id a lot rather have a false alarm than miss the opportunity to stop a stroke, she says.


Stroke symptoms are characterized by changes that come on quickly, such as suddenly having trouble walking or experiencing dizziness; sudden severe and unusual headaches; a sudden weakness or numbness of the face, arm, or leg; sudden confusion or trouble speaking or understanding speech; or sudden trouble seeing.


A simple pre-hospital test that can be done over the phone with a health provider can help determine if an individual might be suffering a stroke. Within a matter of seconds of experiencing a possible symptom, having the person say a simple sentence, smile or grimace, and test his or her hand-grip from outstretched arms can often determine if a stroke caused the symptom.


Transient ischemic attacks (TIAs), called mini strokes or warning signs by Nash, are experienced by the fortunate minority of stroke victims who have a good chance of recovering from their symptoms.


Geraghty says one of her life goals is to change the standard practice of how hospitals deal with TIAs. All too often, she says, they give a patient a CT scan and, if no damage is found, send them home.


I want to get more aggressive, admit the patient into the hospital, and try to find the source of the TIA, says Geraghty, who moved to Spokane this month from the Midwest, where she became an accredited neurologist at the University of Wisconsin, then spent two more years studying strokes as a specialty. Additional treatment at a hospital might include doing an ultrasound of the neck or an MRI of the blood vessels in the brain, she says.


Within the first 24 hours after a TIA, theres a big chance of a full-fledged stroke hanging around the corner, and we have a chance to check it, Geraghty says.


Until 1995, stroke victims, even those who were admitted immediately to a hospital, had little chance of intervention, because no approved medicine was available.


Then, the U.S. Food and Drug Administration approved tissue plasminogen activator (TpA) as the first and so far only clot-busting medicine to treat stroke victims, says Geraghty. Nash says the drug can be given intravenously within three hours after a stroke occurs to dissolve a clot, and between three and five hours after a stroke it can be administered by use of a catheter from the groin area, reaching affected arteries in the head.


Yet Geraghty says the drug is seldom used.


Of the people who need this drug, only about 4 percent get it, she says, adding that treatment often is available too late to make a difference. Thats because many times stroke isnt recognized for what it is, and also because many physicians refuse to administer the drug without a neurologist standing by.


Statistically, TpA has a 6 percent chance of causing bleeding in the brain and some doctors shy away from the potential liabilities. Yet, some doctors who have refused to administer TpA to patients in need of the clot-removing drug have been suedand have lost for not doing so, Geraghty says.


Many times the benefit far outweighs the risk, she says.


Nash says other drugs to expand the treatment window beyond three hours are now being studied by the FDA. Its very exciting, she says.


One such potential drug, called ReoPro, is in the trial stages and is expected to be an effective treatment up to five hours after a stroke, says Geraghty. Another drug being studied, called Desmoteplace, is a synthetic derivative of vampire bat spit that could extend the therapeutic window up to nine hours, she says.


Geraghty says that in a stroke center like Sacred Heart, there are other options available to treat a stroke victim as long as the exact location of the clot is known. She says in some instances highly-skilled surgeons can use a new piece of surgical equipment, called a MERCI device, that acts like a corkscrew and unscrews the clot out of the blood vessel. In other instances up to 12 hours after a stroke, TpA, in small amounts, can be applied directly to the clot by an X-ray-guided catheter inserted into the body in the groin.


Strokes are where heart attacks were 20 years ago, says Geraghty, who says shes one of only about 200 or so stroke-certified neurologists in the U.S. I feel we are on the verge of understanding stroke as a disease, and that we can soon recognize strokes like people do heart attacks. That way people can get treatment a lot sooner and reduce the amount of the disability.