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Am Fam Physician. 2003;67(5):1111-1112

Stroke, a leading cause of disability and death, is best managed by rapid identification and treatment. Women with strokes have higher rates of morbidity and mortality than men. These worse outcomes among women are probably related to late diagnosis caused by triage delay secondary to unusual symptom presentations. Labiche and associates looked at the presenting symptoms of strokes in men and women to determine whether a sex difference exists.

They examined data from the TLL Temple Foundation Stroke Project, a prospective surveillance project in 10 community nonurban hospitals from February 1998 to March 2000. Data were collected from emergency department and hospital admission logs. As soon as possible after case identification, formal patient interviews were conducted with the patient or a person who was familiar with the patient's presenting symptoms. Symptoms were classified into 14 categories; 12 represented traditional and nontraditional stroke symptoms, one represented unclassifiable symptoms that might be neurologic but are not typical (such as nausea, generalized weakness, hiccups), and one represented nonspecific symptoms unlikely to be neurologic in origin (such as chest pain, palpitations).

Detailed interview data on cerebrovascular events were obtained for 1,124 cases, which made up 94.5 percent of all cases identified. Women were more likely to be older and white. Men had higher rates of tobacco use and higher income. Women were significantly more likely to have hemorrhagic stroke, intra-cerebral or subarachnoid, than were men. Traditional stroke symptoms including imbalance and hemiparesis were more common among men, while nontraditional stroke symptoms such as pain, change in level of consciousness, and disorientation were more common among women.

The authors conclude that delayed diagnosis of acute stroke in women might be caused by sex differences in presenting symptoms, with women reporting nontraditional symptoms (e.g., pain, change in level of consciousness, disorientation, and non-neurologic symptoms) more commonly than men. Stroke triage personnel should be vigilant for these symptoms in women.

In an editorial in the same journal, Washington and Bird note the importance of recognizing the sex differences in disease presentations, notably in acute myocardial infarction and stroke. Further research is encouraged to look at sex differences in the way diagnoses are made and treatments selected, to elucidate the outcome differences between men and women for many medical conditions.

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