By Matthew E. Fink, MD
Louis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, New York Presbyterian/Weill Cornell Medical College
SOURCE: Ali M, van Os HJA, van der Weerd N, et al. Sex differences in presentation of stroke: A systematic review and meta-analysis. Stroke 2022;53:345-354.
There have been anecdotal reports and small case series that have suggested women may present with symptoms that are different from men at the onset of ischemic stroke or transient ischemic attacks. These investigators conducted a systematic review of the literature and meta-analysis of high-quality cohort, cross-sectional, case-control, or randomized controlled trials of ischemic or hemorrhagic stroke to determine if there was a difference in presenting symptoms between men and women.
They reviewed 60 studies, which included more than a half-million people (50% women). Their data suggested that headache occurred more frequently in women than in men with any type of stroke, as well as changes in consciousness and mental function. Other non-focal neurological symptoms, such as dizziness, occurred less frequently in women. But overall, the presence of focal symptoms was not associated more with either sex, except for focal visual disturbances, which occurred less frequently in women compared with men. However, the investigators noted that most of the studies contain many possible sources of bias in the ascertainment of symptoms at the onset of the stroke. They concluded that additional high-quality studies are needed to address this issue. If there are sex differences in the clinical presentation, this may lead to misdiagnosis and inappropriate or lack of treatment.
