Public Release: 

Women's stroke symptoms differ from men's, often aren't 'traditional' signs, study finds

First-ever finding of sex difference could help women get treated faster, better

University of Michigan Health System

ANN ARBOR, MI - A new study documents for the first time a significant difference in the way women and men describe their symptoms while they're having a stroke. And that difference may be affecting how women receive emergency stroke treatment.

On the whole, the study found, women were 62 percent more likely than men to say they were feeling sensations that aren't on the list of "traditional" stroke symptoms.

Because emergency responders and emergency room doctors often go by patients' descriptions and the traditional symptom list when trying to diagnose and treat a suspected stroke, women's symptoms may be overlooked during the precious hours when stroke therapies work best, the researchers say. Delays in treatment with clot-busting drugs can lead to long-term disability or even death from a stroke.

The study, published in the November issue of the Annals of Emergency Medicine by stroke specialists from the University of Michigan Health System and the University of Texas at Houston, concludes that recognition of the symptom differences could help women be evaluated and treated faster and more effectively.

The new results, from the TLL Temple Foundation Stroke Project, may help explain findings from other research showing that women often don't get stroke treatment as quickly as men.

"Our findings have important consequences for stroke diagnosis and treatment," says senior author Lewis Morgenstern, M.D. "All stroke treatments are time-dependent, so if women are not diagnosed promptly, it will slow down the effort to treat them." Morgenstern directs the U-M Stroke Program and is an associate professor of Neurology, Epidemiology, Emergency Medicine and Neurosurgery at the U-M Medical School and School of Public Health.

He adds, "These differences are both biologically interesting and socially consequential. They are important to medical education, too, because often medical students and others are trained that stroke is a man's disease. It's not."

Lead author Lise Labiche, M.D., a Stroke Fellow at the UT Health Science Center at Houston, agrees. "Unless diseases are specifically studied in women, it can be wrongly assumed that women and men behave the same way. It is crucial to recognize that differences do occur between the genders. In stroke, prompt recognition of non-traditional stroke symptoms by patients, paramedics and ER staff may increase the number of women receiving clot-dissolving drugs and reduce the disability that they suffer."

Stroke is the leading cause of disability in American adults, and the third leading cause of death. Previously, studies have show that women who have a stroke are more likely to die than men, or if they survive, more likely to have a poor outcome. Research has recently shown that women having a stroke face longer delays than men in being evaluated by emergency room physicians.

The study looked at interview transcripts and medical information from 1,124 men and women who came to 10 rural and suburban hospitals in east Texas between February 1998 and March 2000 with conditions that were later positively identified as acute strokes.

The interviews -- which asked about the symptom or symptoms that caused the patient to seek medical attention -- were conducted with the patient or, if the patient could not participate, with a person familiar with the patient's initial symptoms.

A researcher who did not know the sex of the patients then reviewed the interviews and other data, and classified the symptoms for each patient using 14 categories. These included traditional stroke symptoms like sudden changes in sensation, walking ability, balance, motor functions (including paralysis of one side of the body), speech, language abilities, facial muscles, vision and dizziness.

But the researchers also included nontraditional symptoms like headache, face pain and limb pain; disorientation and change in consciousness; various neurologic symptoms like hiccups, nausea and general weakness; and symptoms that aren't likely to be neurologic, such as chest pain, shortness of breath, and palpitations.

The findings showed that overall, 28 percent of women reported nontraditional stroke symptoms, as opposed to 19 percent of men. Statistically significant sex differences were found for four specific symptom categories: men were more likely to report the traditional symptoms of imbalance and paralysis of one side of their body, while women were more likely to report nontraditional symptoms of pain and changes in consciousness or disorientation.

Women were generally more likely than men to report non-neurologic symptoms like chest pain and shortness of breath, while men were somewhat more likely to have problems with their ability to walk. There was no difference between the sexes in speech problems, facial muscle problems, dizziness/vertigo, sensation, language, visual problems or unclassifiable neurologic symptoms. A majority of patients -- 58 percent -- reported multiple symptoms.

Women's symptoms overall were not only less traditional, but also less specific. This could further delay detection of the symptoms' source and treatment decisions. "The diagnosis of stroke is usually cut and dried, but when symptoms are generalized and vague, it's hard to make a clear diagnosis," says Morgenstern.

With the new findings providing the first evidence of a gender difference in stroke symptoms, Morgenstern hopes that other researchers will try to validate the data by doing a prospective study designed specifically to look at symptoms in women and men. If such a study were to reach the same conclusions, he says, it might be time to add to the list of stroke symptoms.

Until then, he urges women to become more familiar with the traditional symptoms of stroke -- sudden onset of weakness or numbness on one side of the body, difficulty speaking or understanding, facial drooping, clumsiness or inability to walk. And, he suggests women assess their personal risk of stroke based on their age and medical history, and talk to their medical providers about how to reduce their risk. He also emphasizes the importance of seeking immediate medical attention for any sudden change in a person's condition.

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