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Dear Doctor: I’ve been on blood pressure medication for 20 years and am now going through menopause. For me, this includes anxiety attacks. Symptoms of stroke and anxiety attacks seem pretty similar. How can I know for sure if I’m having a stroke versus an anxiety attack?

Dear Reader: It’s true that the hormonal changes that take place during menopause, specifically to estrogen and progesterone, can result in feelings of anxiety that range from mild to extreme. And while an anxiety attack is considered a psychological disorder, it causes physical effects that can be distressing. That’s because when we become anxious, stressed or panicky, our brains send signals to the body that it should prepare to protect itself, either through fight or flight. Those signals include the release of adrenaline and cortisol, which are often referred to as stress hormones. They cause the heart to race and the blood vessels to constrict, which can result in symptoms like dizziness, nausea, feeling faint, sweating, tingling sensations or numbness in the hands and feet, muscle weakness, heart arrhythmias, sudden headache, and a sense of dislocation or unreality.

Stroke, meanwhile, is a physical event. It occurs when blood flow to the brain is interrupted. A lack of blood means a lack of oxygen, which causes brain cells to begin to die. In a hemorrhagic stroke, a weakened blood vessel either leaks or ruptures. In an ischemic stroke, an obstruction impedes the flow of blood. When the interruption of blood flow is temporary, this is known as a transient ischemic attack, or TIA.

As you say, anxiety attacks and all three types of stroke can share overlapping symptoms. The strokes themselves can vary in the way that they present. However, one thing that all strokes have in common is the sudden onset of symptoms. These include:

  • Sudden numbness or weakness in arms, legs or face, particularly when it affects just one side of the body.
  • Trouble seeing or a loss of vision that affects one or both eyes.
  • A sudden onset of confusion, inability to understand speech or the inability to speak.
  • The instant onset of a massive headache.
  • The abrupt loss of coordination, balance or the ability to walk or move about.

If you do ever experience any of these symptoms, call 911. It’s vital to seek medical care immediately. If possible, make note of the time the first symptom appeared, as this is information that may affect treatment decisions. The Centers for Disease Control and Prevention recommend calling 911 over accepting a ride to the hospital. Response times are swift, and paramedics can start life-saving treatment the moment they reach you. This may seem obvious, but never try to drive yourself to an ER if you suspect a stroke. You can become incapacitated while behind the wheel.

Finally, we believe it’s wise to talk to your family doctor about the anxiety attacks. Although a certain level of anxiety can accompany menopause, anxiety attacks, particularly if they are ongoing, are unusual. At the very least you can discuss your fears about stroke with your doctor. And it’s quite possible she or he can help you with medications or other interventions to lessen the impact of your symptoms.

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Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.

Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.

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