[health-vn] Stroke symptoms in women and men

[Vern Weitzel]

Subject: [procor] Stroke symptoms in women and men
Date: Wed, 27 May 2009 12:42:37 -0400
From: ProCor <procor at procor.org>
Reply-To: Global Dialogue <procor at list.procor.org>
To: Global Dialogue <procor at list.procor.org>

[Read this research reviews in the Women’s Heart Health section of ProCor: 
www.procor.org/issues/issues_list.htm?attrib_id=17152.]

Women did not differ significantly in the prevalence of traditional stroke 
symptoms, suggesting that the focus of stroke prevention education for women 
should continue to emphasize traditional stroke risk factors...

Title: Gender differences in presenting and prodromal stroke symptoms

Authors: EM Stuart-Shor, GA Wellenius, DM DelloIacono, MA Mittleman

Reference: Stroke 2009; 40: 1121-1126, 
http://stroke.ahajournals.org/cgi/content/full/40/4/1121 (open access)

Reviewer: Robert Goldberg, PhD, Contributing editor, ProCor; Professor of 
Medicine and Epidemiology, Division of Cardiovascular Medicine, University of 
Massachusetts Medical School, Worcester, Massachusetts, USA

Problem addressed: Presenting symptoms of acute stroke.

Purpose of study: To examine possible differences between men and women with 
regards to the premonitory (prodromal) and presenting symptoms of acute stroke.

Location of study: Boston, Massachusetts, USA

Study design: The study sample consisted of adult patients admitted to a single 
tertiary care hospital in Boston, with symptoms suggestive of an acute stroke 
over an approximate five-year period beginning in 1999. All patients had a 
neurologist confirmed acute ischemic stroke. Information was collected by 
trained data abstractors with regards to patient's demographic characteristics, 
medical history (including medications), and acute and prodromal symptoms. The 
prodromal symptoms of stroke were defined as patient self-reported symptoms that 
preceded the 24 hours prior to hospital admission; the acute symptoms were 
defined as those that occurred within the 24 hours of admission to the hospital 
as noted by the patient or by a witness/proxy respondent.

Results: A total of 1107 consecutive patients were hospitalized with an ischemic 
stroke during the period under study; the sample consisted of 608 women (55% of 
total) and 499 men. Approximately two-thirds were white and the mean age of this 
patient sample was 73 years; hospitalized women were significantly older than 
men (76 vs 70 years) at the time of onset of their acute stroke.

In examining differences in various comorbidities and admission medications 
between men and women, women were more likely to have a history of CHD, 
diabetes, dyslipidemia, and current smoking than men whereas there were no 
gender differences in average BP levels at the time of hospital presentation. 
Both men and women had been previously diagnosed with two or more clinically 
important comorbidities (74% and 69%). At the time of hospital admission, women 
were significantly less likely to be treated with aspirin (39% vs 46%) and 
statins (23% vs 38%) than men while they were significantly more likely to be on 
current diuretic therapy. A number and variety of different presenting 
symptomatologies were contrasted between men and women in both crude and 
age-adjusted analyses.

After adjustment for differences in age at the time of hospital presentation, 
women were as likely as men to report various symptoms of acute stroke within 
the 24 hours of hospital admission including numbness, weakness, headache, 
nausea, malaise, changes in vision, difficulty in walking or speaking, as well 
as in the occurrence of several more non-specific symptoms. The most commonly 
reported presenting symptoms were weakness (81% of women and men), difficulty in 
speaking (50% of women; 55% of men), and difficulty in walking (30% of women; 
34% of men). Moreover, women (98%) were as likely as men (98%) to report one or 
more of the symptoms classically associated with the onset of acute stroke.

Similarly, in examining both the frequency, as well as type, of prodromal 
symptoms of possible stroke between men and women, there were no appreciable 
differences in the reporting of these premonitory symptoms between men and 
women. The most common prodomal symptoms reported by women and by men, 
respectively, were weakness (37% vs 50%), difficulty in speaking (31% vs 35%), 
and difficulty in walking (23% vs 30%). Prodromal symptoms were reported by a 
total of 35% of women, and by 36% of men, and the type of prodromal symptoms did 
not vary according to sex. Both classic as well as less commonly reported 
prodromal symptoms were less often reported by both men and women as compared to 
the acute symptoms during the first 24 hours of hospital admission.

Comments: A fairly extensive literature exists describing the constellation of 
acute as well as prodromal symptoms, as well as extent of delay in seeking 
medical care in persons experiencing these symptoms, by patients experiencing an 
acute myocardial infarction (AMI). These studies have shown that patients with 
an evolving AMI experience a variety of symptoms, most notably symptoms of chest 
pain, pressure, and tightness, as well as other symptoms involving the arms, 
shoulders, jaw, and back. Gender as well as age specific differences have been 
noted with regards to this acute symptom profile with women being more likely to 
report "atypical" symptoms associated with AMI than men. On the other hand, both 
men and women continue to exhibit relatively prolonged delay in seeking medical 
care in the setting of AMI. These health care seeking practices place both men 
and women at greater risk for not receiving proven cardiac medications, whose 
efficacy has been linked to time; delays in seeking acute medical care also 
place both men and women experiencing an AMI at greater risk for adverse outcomes.

In contrast to the published literature on AMI, relatively little is known about 
potential differences between men and women with regards to the symptoms of 
acute stroke and whether these symptoms are associated with delays in seeking 
medical care. This is an extremely important topic given the magnitude of acute 
stroke and the importance of seeking care within a few hours of acute symptom 
onset to receive the time dependent benefits associated with the administration 
of clot lysing therapy.

The results of the present study are particularly informative in that they 
provide relatively contemporary insights into the prodromal as well as acute 
symptoms of ischemic stroke experienced by both men and women, demonstrating 
that relatively few differences exist between the sexes in their acute symptom 
profile.

These results are of importance for trialists as well as health educators who 
are involved in the design and conduct of educational campaigns in the community 
which encourage patients with acute CVD to seek medical care as quickly as 
possible. This information is also of considerable relevance for health care 
providers who are involved in the prevention as well as management of patients 
with acute stroke.

Additional contemporary data remains needed that will examine the relation of 
individual symptoms, and symptom clusters, to patient's care seeking behavior 
and identification of the most effective approaches to encouraging both men and 
women to seek care in as rapid a fashion as possible should the signs and 
symptoms of acute stroke appear. These efforts should lead to the enhanced 
treatment of patients with acute stroke and to improvements in their long-term 
prognosis, quality of life, and functional status.