Women’s Stroke Symptoms Differ from Men’s
First-Ever Finding of Gender Differences Could Improve Treatment

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, which may affect how women receive emergency stroke treatment.

Researchers found that 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 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 time stroke therapies work best, the researchers say. Delays in stroke treatment with clot-busting drugs can lead to long-term disability or even death.

The study, published in this month’s issue of Annals of Emergency Medicine by stroke specialists from The University of Texas Medical School at Houston and the University of Michigan Health System, concludes that recognition of 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.

“Unless diseases are specifically studied in women, it can be wrongly assumed that women and men behave the same way,” said lead author Lise Labiche, M.D., a stroke fellow at UT-Houston “It is crucial to recognize that differences do occur between the genders. In stroke, prompt recognition of nontraditional stroke symptoms by patients, paramedics and emergency staff may increase the number of women receiving clot-dissolving drugs and reduce the disability they suffer.”

Stroke is the leading cause of disability in American adults, and the third leading cause of death. Previous studies have shown 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 overall findings showed that 28 percent of women reported “nontraditional” stroke symptoms, as opposed to 19 percent of men. Nontraditional symptoms included headache, face and limb pain, disorientation and change in consciousness, hiccups, nausea and general weakness, and symptoms that aren’t likely to be neurological, such as chest pain, shortness of breath, and palpitations.

Statistically significant sex differences were found for four specific symptom categories. Men were more likely to report 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-neurological 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 neurological symptoms. Fifty-eight percent of patients reported multiple symptoms.

Women’s symptoms were not only less traditional, but also less specific. This could further delay detection of the symptoms’ source and treatment decisions.

“These differences are both biologically interesting and socially consequential,” said senior author Lewis Morgenstern, M.D., formerly of UT-Houston and now with the University of Michigan. “They are important to medical education, too, because often medical students and others are taught that stroke is a man’s disease, when it clearly isn’t.”

Morgenstern urged 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.

He suggested that 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 emphasized the importance of seeking immediate medical attention for any sudden change in a person’s condition.

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