Sølvi Monsen Bagge was at the cabin with her family when she got a severe headache. – I am a nurse, so I immediately thought that this is not a normal headache. She googled cerebral hemorrhage and stroke. Because that was what she suspected herself. But she had no other symptoms. The pupils were fine, and she had no trouble speaking or was out of energy. – I told the man that we don’t think much of it. I took two paracetamol and went to bed. But the headache was so severe that she couldn’t sleep. The neck pain also came on the morning branch. Then she called the doctor and said she was on a trip. Passed out The couple rowed across the water and drove to the doctor. – I had slightly elevated blood pressure, but you can get that when you are in pain. So the doctor thought it was a slipped disc in the neck, and sent me home with Paralgin forte, says Bagge. But the pain didn’t go away. The following day the man went to work, while a friend came by because she was worried since Sølvi was in so much pain. – And while she was there, I passed out. And then I was just about to die. Luckily there was an ambulance nearby. With a doctor who quickly realized that this was a stroke. It was entitled to treatment at St. Olav’s in Trondheim, and later the University Hospital in Tromsø. In total, she was in a coma for four weeks. Many women have “unusual” symptoms When a serious stroke strikes, seconds and minutes count. It is a very time-critical disease, where getting treatment as soon as possible is crucial for how life will be afterwards. Then it is also important that most people, and not least health personnel in the front line, such as those who work in the ambulances, know what to look for in terms of symptoms. – More than 3 out of 10 strokes are not detected if we only focus on the typical symptoms. Gender is important for stroke, too little attention has been paid to this. That’s what neurologist and PhD student Ida Bakke at Nordlandssykehuset says. She does not know Bagge’s medical history, and talks about strokes in general. Ida Bakke, specialist in neurology at Nordlandssykehuset Photo: Benjamin Fredriksen / news Previous studies have largely been done on middle-aged men. It is well known among healthcare personnel and the general public that women who suffer a heart attack experience other symptoms than the characteristic chest pain with radiation to the neck and arm. For stroke, there has not been the same focus on the fact that women often have other symptoms. This week is “Brain week”. Bakke, together with three others from Oslo University Hospital, wrote a debate article to focus on stroke in women. A month in a coma Sølvi Monsen Bagge was in an artificial coma for a month. The brain haemorrhage she has had is more rare than a normal stroke, but is characterized just as much as a stroke: Subarachnoid haemorrhage The type of brain haemorrhage Sølvi Monsen Bagge was given the name subarachnoid haemorrhage, which is a haemorrhage in the space between the two meninges, the arachnoid and the pia mater, that is the subarachnoid space where it is cerebrospinal fluid. The main symptom of spontaneous subarachnoid haemorrhage is a sudden onset, very severe and typically persistent headache, which begins as a sudden “bang in the head”. The bleeding can occur in connection with physical exertion or other conditions that increase blood pressure if the patient has an underlying weakness in the blood vessels in the brain. The headache is often accompanied by nausea and/or vomiting. Some may also experience neurological symptoms such as paralysis, speech difficulties or epileptic seizures. In some cases, the patient has reduced consciousness, especially with increased pressure in the brain. After a few hours and days, neck stiffness often occurs due to secondary irritation and non-infectious inflammation of the meninges, but this is therefore a late symptom. Source: Major medical encyclopedias. After Sølvi woke up, she was sent home to Kirkenes and the hospital there. In total, she was in hospital for five months. Stroke patient Sølvi Monsen Bagge was in a coma for a month after a serious brain haemorrhage. Photo: Private – No one at the hospital thought I would come home. Because I was so hurt. I was in a wheelchair. I thought my daughter was seven years old and didn’t know the old man. I couldn’t find it, I had no memory, I was completely gone, she says. It is now seven years since the evening at the cabin, when Sølvi got a severe headache. In retrospect, she has had more thoughts about what happened afterwards. Because the stroke has destroyed a lot. Today, she is declared 44 percent medically disabled. She has also received compensation from Norwegian Patient Injury Compensation. – If I had been sent directly to hospital for a CT, I would probably have spent a week in hospital. Then it would perhaps be a matter of 5 percent medical disability. At the same time, she understands that you can’t send everyone who comes with a headache to a CT or MRI, it will cost an enormous amount. – There is, of course, economics in it as well. But there is a difference between a headache and a headache. If you see what I have cost society for seven years, there are many millions in ambulance flights, hospital stays and lots of professionals in these years. Sølvi the climbing wall at Sunnaas hospital. Photo: Private photo Sølvi Monsen Bagge has decided not to be bitter. – It is human to make mistakes. And we have a fantastic healthcare system. I would never have been as healthy as I am today had it not been for everything they have done for me. New studies from Australia Large international studies, including a study from Australia with over 200,000 patients show that women more often have other symptoms than men. – You have to think differently about women, and look for more symptoms, symptoms than difficulties with smile, talk and lift, says neurologist Ida Bakke. “Talk, Smile and Lift” has been what people have learned in public information campaigns. The majority of women will have one of these symptoms. But more than 30 per cent do not want any of these. This is shown by figures from international studies and from the Norwegian Stroke Register, according to neurologist Ida Bakke at Nordlandssykehuset. – We know that symptoms of stroke are more than paralysis and difficulty speaking as, for example, acute visual disturbance and dizziness. But the fact that women have more frequent headaches, nausea, mental changes, impaired consciousness and weakness in the body is new knowledge. The stroke specialists will have more focus on gender differences Lack of knowledge can lead to undertreatment of stroke patients who do not have the typical stroke symptoms. This is very unfortunate. To counteract this, there is a need for more research in addition to increased attention to gender differences in stroke symptoms, both in the general population and among healthcare professionals. When the national stroke information campaign is to be revised, it should include new knowledge about women’s stroke symptoms. (from the chronicle of the researchers Maren Ranhoff Hov, Karianne Larsen, Ida Bakke, Else Charlotte Sandset in Tidsskriftet Den norske legeforeing) The stroke specialists will have more focus on gender differences. – Lack of knowledge can lead to undertreatment of stroke patients who do not have the typical stroke symptoms. This is very unfortunate. Researchers and doctors who have written a debate article to draw attention to women’s stroke symptoms. From left Karianne Larsen (OUS and SNLA), Maren Ranhoff Hov (OUS and SNLA), Else Charlotte Sandset (OUS and SNLA) and Ida Bakke (Nordlandssykehuset) Photo: Jon Tonning / Stiftelsen Norsk Luftambulanse (SNLA) To counteract this, there is there is a need for more research in addition to increased attention to gender differences in stroke symptoms, both in the general population and among healthcare personnel, she adds. Bakke believes that research must pay more attention to gender differences in stroke symptoms and causes of stroke. – We generally want more research into brain health. Disease in the brain and nervous system affects a third of the population during their lifetime. It is a great sadness not to be at work Sølvi Monsen Bagge is grateful that things are moving forward, albeit slowly. Sølvi Monsen Bagge is still working on training herself after the brain haemorrhage seven years ago. Photo: Private photo – Actually, maybe I should have been seven feet underground. The injuries I had were so great. She says that she struggles with fatigue. – The exhaustion means that I have to regulate my activity very much and not do too much. I have to have a schedule to be able to have good days. The 51-year-old has had to learn to live life again. – It is almost a miracle that it has gone so well with me. Sølvi and her husband David. Photo: Private photo She hasn’t had the strength to try her hand at work again. – I miss my job as a nurse, it is my great sorrow that I am not in work. Bagge hopes that more research will be done on women and stroke symptoms. As a nurse, she herself has helped implement the “smile, talk promise” campaign. She herself had no such symptoms. – We must not be blinded by the “old” symptoms. We have to get the new knowledge out to people. Every healthcare worker must think when there is a severe headache, and at least when there is neck pain as well, that the patient should go straight for a CT scan. They would rather have too many CTs than too few.
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Symptoms of a stroke – Sølvi had an intense headache and ended up in a coma – news Nordland
