Canadian study encourages doctors to look beyond typical symptoms for stroke
Credit: Adrian Shellard for the Hotchkiss Brain Institute
Women experiencing a minor stroke or transient ischemic attack (TIA) are less likely to be diagnosed with a stroke compared to men — even though they describe similar symptoms in emergency departments.
“In our study, men were more likely to be diagnosed with TIA or minor stroke, and women were 10 per cent more likely to be given a non-stroke diagnosis, for example migraine or vertigo, even though men and women were equally likely to report atypical stroke symptoms,” says study lead author Dr. Amy Yu, MD, a stroke neurologist at Sunnybrook Health Sciences Centre and assistant professor at the University of Toronto.
The findings of the study are published in JAMA Neurology and were presented May 22 at the European Stroke Organisation Conference in Milan, Italy.
The study found men and women equally described atypical stroke symptoms such as dizziness, tingling or confusion which are not commonly thought of as related to stroke. Typical symptoms of stroke are sudden weakness, face drooping, or speech difficulties.
A TIA occurs when there is temporary interruption of blood flow to the brain, and is often a warning sign of another stroke. TIAs can also be associated with permanent disability.
Discrepancy in diagnoses
“Our study also found the chance of having another stroke or heart attack within 90 days of the diagnosis was the same for women and men,” adds senior author Dr. Shelagh Coutts, MD, a stroke neurologist with Alberta Health Services at Foothills Medical Centre, associate professor at the University of Calgary’s Cumming School of Medicine (CSM) and member of the Hotchkiss Brain Institute at the CSM.
Researchers say while further research is needed, it is possible that patient reporting of symptoms, interpretation of symptoms by clinicians, or a combination of both, could explain the discrepancy in diagnosis among men and women.
“Our findings call attention to potential missed opportunities for prevention of stroke and other adverse vascular events such as heart attack or death in women,” adds Coutts.
Previous studies on this topic have focused on patients diagnosed with stroke. Researchers in the current study included 1,648 patients with suspected TIA who were referred to a neurologist after receiving emergency care from 2013-2017, regardless of their final diagnosis.
Spotlight on atypical symptoms
Researchers note it is an important opportunity for the public and clinicians to be aware of atypical symptoms of TIA.
“What’s important to recognize in stroke is that the brain has so many different functions and when a stroke is happening, people can feel different things beyond the typical stroke symptoms,” says Yu. “Accurately diagnosing TIA and stroke would change a patient’s treatment plan and could help prevent another stroke from happening.”
Funding for the study was provided by Genome Canada, Genome B.C., Genome Alberta, and the Heart and Stroke Foundation of Canada.
Dr. Amy Yu, MD, is an assistant professor at the University of Toronto, an associate scientist at the Sunnybrook Research Institute, and stroke neurologist at the Sunnybrook Health Sciences Centre.
Dr. Shelagh Coutts, MD, is an associate professor in the departments of Clinical Neurosciences, Radiology, and Community Health Sciences and a member of the Hotchkiss Brain Institute at the Cumming School of Medicine, University of Calgary.
Led by the Hotchkiss Brain Institute, Brain and Mental Health is one of six research strategies guiding the University of Calgary toward its Eyes High goals. The strategy provides a unifying direction for brain and mental health research at the university and positions researchers to unlock new discoveries and treatments for brain health in our community.
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