When Jennifer Salomon woke up with a bad headache, she figured it was due to lack of sleep. Just three days earlier she had given birth to her first child, Kelsey. But soon after getting out of bed, the 27-year-old collapsed.
“At the time, I didn’t know what was going on, only that I couldn’t stand up,” recalled Salomon, now 39, of that fateful day in 2005. “I said to my husband, ‘Something’s wrong, call an ambulance,’ but it came out as grunting because I had lost my speech.”
When the paramedics arrived at her Levittown home, Salomon’s blood pressure was 200 over 110 – she’s normally 120 over 80.
She was having a stroke caused by postpartum preeclampsia, a rare condition that occurs when a woman has high blood pressure and excess protein in her urine soon after childbirth.
Yet, “I had no signs of preeclampsia pre-birth,” she said.
After a week in Jefferson Hospital, Salomon spent the next four months at Magee Rehabilitation Hospital, two months in-patient and two more out-patient for physical, occupational and speech therapies. Visits from her newborn provided incentive to get better, Salomon said. “I wanted to be able to be her mother.”
Today, she wears a brace on her right leg and still doesn’t have full movement of her right arm and hand, though she has learned to write with her left hand.
Salomon is among the more than 795,000 people in the United States who have a stroke each year, according to the Centers for Disease Control and Prevention. Stroke is the third leading cause of death for women and kills twice as many women as breast cancer.
Because stroke risk increases with age, and women live longer than men, more women than men are affected.
But the percentage of strokes in women age 45 or younger is also increasing. Some of the causes for strokes aren’t clear. Others are due, in part, to health conditions that traditionally affect older people, such as obesity, diabetes, high cholesterol, and high blood pressure. Additionally, young women are at higher risk when they are pregnant, have certain types of migraines, or take birth control pills while being a smoker, said Michelle J. Smith, system chief of neurosurgery at Main Line Health.
Some younger women who have strokes learn they have rarer conditions that were not diagnosed until after the stroke.
Two main types of stroke
A stroke is a cutoff of the blood supply to a portion of the brain, which can happen in two ways.
Ischemic stroke occurs when there is a clot within a blood vessel either leading to the brain or within the brain itself. It starves the brain of oxygen and results in permanent brain injury, explained Smith.
Hemorrhagic stroke occurs when a blood vessel is weakened and bursts, causing direct injury to the brain.
“As a result, there’s damage to the brain tissue, which can result in permanent physical changes,” said Andria Jones, cardiologist at Jefferson Health. “They can be symptoms that can last for a long period of time or they can just be temporary, so a loss of vision for just 20 minutes can be a warning sign that a stroke is coming on.”
Those symptoms include trouble with speech, memory, concentration, weakness of a body part (typically arm, leg or facial muscle), dizziness, loss of vision, balance and coordination. Also, a severe headache without any known cause could be a sign of a stroke.
One woman, multiple strokes
Sometimes, it can take days to diagnose a stroke because the symptoms can masquerade as something else entirely.
Allison Bevan, 35, was at work last October when she suddenly became very dizzy.
“I felt like the room was spinning and I was almost upside down,” recalled the Pottstown resident. Her coworkers called 911 and she was taken to the hospital. Diagnosed with vertigo, she was given medication and sent home.
But that evening, the dizziness returned. Back at the hospital, CT scans were normal but she was admitted for observation. After three days, her neck began to hurt, and a CTA, a computed tomography angiography that uses contrast material and CT scanning, discovered that her right vertebral artery was torn.
Bevan took clot-busting medication and was released after a week.
The next morning, she had another, more massive stroke. She was admitted to a Pottstown hospital, where she had a virtual consultation with a doctor from Jefferson University in Philadelphia, who examined her by a screen on a robot.
“They held my eyes open so he could review them and he was yelling that they had to fly me to Jefferson right now,” she recalled.
There they discovered another, larger stroke.
“The strokes were in the cerebellum, the back of my brain, the part that controls equilibrium, your balance, and the communication between your brain and your eyes,” she said.
Her doctors aren’t sure what caused the torn arteries that prompted her strokes, said Bevan. Weight is not a risk factor in that type of stroke, but she lost 20 pounds in the course of her ordeal and is focusing on healthy habits.
Now back at work, Bevan is staying with her folks in Souderton to be closer to her sales job because she’s still not comfortable driving long distances. She goes to rehab two or three times a week for therapy to improve balance and reduce problems related to dizziness. She still has trouble following objects with her eyes.
“It’s a struggle, but every day gets a little bit better,” she said. “They told me at six months, whatever symptoms I still feel is the way I’ll always feel.”
In addition to weight management, Bevan has made another healthy change.
“I’ve learned to let things go and not be so stressed. After being so ill, I appreciate life more and live in the moment.”
While not all strokes are preventable, it helps to keep healthy habits, including keeping your weight under control, not smoking, being physically active, and avoiding high blood pressure, high cholesterol and diabetes.
“If you do have those disease processes, keep them under control,” said Jones, who added that atrial fibrillation, an irregular heartbeat, can also lead to a stroke and must be monitored by a doctor.
Getting medical treatment as soon as possible can minimize permanent damage.
“When a patient calls 911, before they enter the hospital, a process has already been initiated,” said Smith. “So as soon as the patient hits the door, there are many things happening right away to reduce the time it takes to treat someone. The faster you get treated, the more brain cells that survive and the better you’re going to do.”
At the same time, new guidelines on ischemic stroke, the type caused by a blockage in the vessel, recognize that for a select group of patients, there’s significant improvement in outcome when treatment for this type of stroke is given after a longer time, 16 to 24 hours.
“It’s opening up the window for many more patients to receive initial treatment,” said Smith.