Sex and acute stroke presentation

Study objectives: We determine whether a sex difference exists for acute stroke emergency department presentation. Methods: The TILL Temple Foundation Stroke Project is a prospective observational study of acute stroke management that identified 1,189 validated strokes in nonurban community EDs from February 1998 to March 2000. Structured interview of the patient and the person with the patient at symptom onset identified the symptom or symptoms that prompted the patient to seek medical attention. Interview data were available for 1,124 (94%) patients. A physician blinded to sex classified the reported symptoms into 14 categories. Results: Nontraditional stroke symptoms were reported by 28% of women and 19% of men (odds ratio 1.62; 95% confidence interval 1.2 to 2.2). Nontraditional stroke symptoms, pain (men 8%, women 12%) and change in level of consciousness (men 12%, women 17%), were more often reported by women. Traditional stroke symptoms, imbalance (men 20%, women 15%) and hemiparesis (men 24%, women 19%), were reported more frequently by men. Trends were also found for women to present with nonneurologic symptoms (men 17%, women 21%) and men to present with gait abnormalities (men 11%, women 8%). There was no sex difference in the mean number of symptoms reported by an individual patient. Conclusion: This study suggests that a sex difference exists in reporting of acute stroke symptoms. Women with validated strokes present more frequently with non-traditional stroke symptoms than men. Recognition of this difference might yield faster evaluation and management of female patients with acute stroke eligible for acute therapies.