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Women Have More Nontraditional Symptoms of Stroke Than Men

SAN DIEGO — February 20, 2009 — “Time is brain,” the saying goes, but women may not get the prompt stroke treatment provided to men, because women do not always present with the more traditional stroke symptoms, according to a study presented here at the International Stroke Conference (ISC) 2009.

“The gender disparities in [stroke] presentation are increasing hospital delays for critical tests,” noted Lynda Lisabeth, PhD, MPH, University of Michigan, Ann Arbor, Michigan, speaking here at a presentation on February 19.

The more traditional symptoms of numbness or weakness on one side of the body, double vision, trouble with words, loss of coordination, and facial weakness may be replaced in women with more vague symptoms that can include altered mental status — disorientation, confusion, or loss of consciousness – headache, and non-neurologic issues.

The objective of this study, Dr. Lisabeth noted, was to prospectively investigate gender differences in acute stroke symptoms to ascertain the need for a larger study. Previous research demonstrated that women were 62% more likely to report nontraditional symptoms than men, which could interfere with prompt therapy with tissue plasminogen activator (tPA).(1,2)

Active surveillance of emergency-department and admissions logs was used to identify ischaemic stroke/transient ischaemic attack (TIA) cases presenting to the University of Michigan Hospital between January 2005 and December 2007. Stroke/TIA symptoms were ascertained through patient interviews and classified as traditional or nontraditional.

“We wanted to build on that research by collecting data from patient interviews, asking them to recall symptoms that brought them to the hospital,” said Dr. Lisabeth, who added that, of all patients approached, almost 90% participated in the questionnaire.

Haemorrhagic-stroke patients were not included because their symptoms could have distorted the findings.

The study found that the methods used were based on frequency and percentage of nontraditional stroke/TIA symptoms and each symptom was calculated by gender and compared using Chi-square tests. Logistic regression was used to compare nontraditional symptoms in women and men adjusted for stroke type (ischaemic stroke vs TIA), proxy use, and age. Sample size for this pilot was based on a predicted odds ratio of 1.8 comparing men and women with respect to nontraditional symptoms (20% prevalence of nontraditional symptoms among men, 5% significance level, 80% power).

Four hundred eighty stroke/TIA cases among 461 individuals were identified; of those, 48.6% were women and 87% were white. The median age in this study was 67 years and did not differ by gender.

Among women, 51.8% reported more than 1 nontraditional stroke/TIA symptom compared with 43.9% of men (P = .09). The most prevalent nontraditional symptom was mental-status change (women 23.2%; men 15.2%; P = .03). The odds of reporting at least 1 nontraditional stroke/TIA symptom were 1.42 times greater in women than in men (95% confidence interval, 0.97-2.06).

The prospective, observational study concluded that women with stroke/TIA were 40% more likely to report any nontraditional symptom and, in particular, altered mental status, compared with men.

Dr. Lisabeth said, “It’s time to think about tailoring stroke information to women like they have already done in heart disease when it comes to atypical symptom presentation.”

1. Labiche LA et al. Ann Emerg Med. 2002;40:453-460.
2. Washington DL, Bird CE. Ann Emerg Med. 2002;40:461-463.


February 27, 2009 - Posted by | 1

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