Gender gap favors men in accurate diagnosis of stroke

  • Yu AYX & al.
  • JAMA Neurol
  • 22 may. 2019

  • de Susan London
  • Clinical Essentials
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Takeaway

  • Women with acute transient or mild neurologic symptoms were more likely than men to receive a diagnosis of stroke mimic, but had similar subsequent stroke risk.

Why this matters

  • Little is known about sex differences in minor ischemic cerebrovascular events.

Key results

  • Relative to men, women:
    • Less likely to receive cerebral ischemia diagnosis (67.8% vs 76.8%; adjusted risk ratio [aRR], 0.88; 95% CI, 0.82-0.95),
    • Similarly likely to have 90-day stroke recurrence (aRR, 0.90; 95% CI, 0.48-1.66), and
    • Similarly likely to have 90-day composite outcome (stroke, myocardial infarction, death; aRR, 0.86; 95% CI, 0.54-1.32).
  • Sexes not significantly different on presenting symptoms.
  • When patients with no focal neurologic symptoms were comparator, diagnosis of cerebral ischemia more likely for those with:
    • Both focal, nonfocal symptoms (aRR, 1.28; 95% CI, 1.15-1.39).
    • Focal symptoms only (aRR, 1.45; 95% CI, 1.34-1.53).

Study design

  • Canadian prospective cohort study, 1648 patients with acute transient or minor neurologic symptoms suspected of having either:
    • Minor ischemic cerebrovascular event (transient ischemic attack, minor stroke).
    • Stroke mimic (syncope, seizure, migraine, peripheral neuropathy).
  • Main outcome: clinical diagnosis (cerebral ischemia vs stroke mimic).
  • Funding: Genome British Columbia; others.

Limitations

  • Patients recruited from academic emergency departments, referred to neurology service.
  • Care after initial diagnosis not collected.