Women less likely to be diagnosed with minor stroke than men: U of T study

Women experiencing a minor stroke or transient ischemic attack (TIA) are less likely to be diagnosed with a stroke compared to men – even though they describe similar symptoms in emergency departments.

That’s according to a University of Toronto-led study published in JAMA Neurology that was presented at the European Stroke Organisation Conference in Milan on May 22.

The study found men and women equally described atypical stroke symptoms such as dizziness, tingling or confusion, but that women were more likely than men to be diagnosed with another ailment.  

“In our study, men were more likely to be diagnosed with TIA or minor stroke, and women were 10 per cent more likely to be given a non-stroke diagnosis – for example migraine or vertigo – even though men and women were equally likely to report atypical stroke symptoms,” says study lead author Dr. Amy Yu, a stroke neurologist at Sunnybrook Health Sciences Centre and assistant professor at the University of Toronto’s department of medicine in the Faculty of Medicine.

A TIA occurs when there is temporary interruption of blood flow to the brain, and is often a warning sign of another stroke. TIAs can also be associated with permanent disability. Typical symptoms of stroke, by contrast, are sudden weakness, face drooping or speech difficulties.

“Our study also found the chance of having another stroke or heart attack within 90 days of the diagnosis was the same for women and men,” adds Dr. Shelagh Coutts, a stroke neurologist with Alberta Health Services at Foothills Medical Centre and an associate professor at the University of Calgary’s Cumming School of Medicine.

Researchers say that, while further study is needed, it’s possible patient reporting of symptoms, interpretation of symptoms by clinicians, or a combination of both, could explain the discrepancy in diagnosis among men and women.

“Our findings call attention to potential missed opportunities for prevention of stroke and other adverse vascular events such as heart attack or death in women,” says Coutts.

Previous studies on this topic have focused on patients diagnosed with stroke. Researchers in the current study included 1,648 patients with suspected TIA who were referred to a neurologist after receiving emergency care from 2013 to 2017, regardless of their final diagnosis.

Researchers note it is an important opportunity for the public and clinicians to be aware of atypical symptoms of TIA.

“What’s important to recognize in stroke is that the brain has so many different functions and when a stroke is happening, people can feel different things beyond the typical stroke symptoms,” says Yu.

“Accurately diagnosing TIA and stroke would change a patient’s treatment plan and could help prevent another stroke from happening.”