Tips for spotting stroke in women

3 minute read

Women have some symptoms of stroke that aren’t the usual suspects, leading to delayed diagnosis and worse outcomes.

An evolving stroke is less likely to be recognised early in women than men, possibly because early symptoms are sometimes different, according to research from the George Institute for Global Health. 

“Both women and men who have been diagnosed with stroke … present more commonly with motor and speech deficits. However, women more frequently present with non-focal symptoms like generalised weakness, mental status change, and confusion, whereas men more frequently present with focal symptoms like ataxia and dysarthria,” said the authors of the paper, which was published in the International Journal of Stroke.

“There is a need to increase awareness of sex differences in symptom presentation in the initial evaluation of acute stroke.” 

Women experience greater disability after a stroke and are much more likely to end up in an institution, the authors said, but improving early diagnosis could lead to better management and outcomes.  

The researchers analysed records for 35,000 people diagnosed with ischaemic or haemorrhagic stroke or transient ischaemic attack, that included data on presenting symptoms, and some of which contained information about delayed and missed diagnoses based on presenting symptoms. 

They found both women and men had a similar incidence of focal symptoms. Motor deficit was an early symptom for 56% of both women and men, and speech deficit for around 40% of both.  

But diffuse, non-focal symptoms were more common for women than for men. Generalised nonspecific weakness was present in 49% of women and only 36% of men. There was a mental status change in 31% of women and 21% of men, and confusion in 37% of women and 28% of men. Other non-focal symptoms included difficulty swallowing, urinary incontinence, headache and dysphasia. 

Women also had a higher risk than men of experiencing non-focal symptoms – a 50% higher chance of generalised weakness, 44% higher chance of mental status change, 42% higher chance of fatigue, and 30% higher chance of loss of consciousness. They also had a 78% higher chance than men of presenting with face or hemibody pain.  

Meanwhile, dysarthria and ataxia were more common in men than women. Only 27% of women had ataxia compared with 44% of men. Women had an 11% lower chance of dysarthria than men, 13% lower chance of dizziness, 21% lower chance of gait disturbance, and were 32% less likely to present with imbalance issues.  

The researchers suggested several possible reasons for the variation in presenting symptoms between men and women, such as differences in the size and location of strokes, and in the presence of small vessel disease. 

“Furthermore, age, traditional cardiovascular risk factors, and cause of stroke can contribute to sex differences in symptoms. Older women have a higher prevalence of atrial fibrillation, leading to a higher incidence of cardioembolic strokes which can result in more severe neurological deficits and cortical findings,” they said. 

While they said the findings could be generalised, more studies using standardised data collection and linking symptoms to missed and delayed diagnosis were needed. 

International Journal of Stroke 2022, online 12 April 

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