Minor stroke diagnosis less likely in women than men, study shows

New research involving patients in Calgary and Victoria shows women are less likely to be diagnosed with minor strokes than men when they show up to emergency rooms.

Migraines, life stress and implicit gender bias may play into difference, researcher says

Dr. Shelagh Coutts, a stroke neurologist and associate professor at the Cumming School of Medicine, says the study found a higher than expected rate of stroke in those considered "low risk." And in 30 per cent of patients studied doctors changed their diagnosis after the MRI. (Riley Brandt, University of Calgary)

Women are less likely to be diagnosed with minor strokes than men when they show up to emergency rooms, according to new research with patients in Calgary and Victoria.

The study, conducted by researchers at the University of Toronto and the University of Calgary, looked at 1,648 women and men who visited emergency rooms in Calgary and Victoria between 2013 and 2017. Their report was published in the peer-reviewed journal, JAMA Neurology.

Despite showing up with similar symptoms, researchers found men were more likely to be diagnosed with a minor stroke or transient ischemic attack (TIA) than women, who were nearly 10 per cent more likely to be diagnosed with another condition, such as migraine or vertigo.

In the following 90 days, the chance of another stroke, a heart attack or death very similar for men and women, the study notes.

"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," stroke neurologist Dr. Shelagh Coutts said.

Coutts, an associate professor at University of Calgary's Cumming School of Medicine, presented the findings with lead author Dr. Amy Yu at the European Stroke Organization Conference in Milan, Italy, on Wednesday.

The million-dollar question, according to lead author Dr. Amy Yu, is why women are less likely to be diagnosed with a minor stroke.

A few factors at play

Although the study didn't look at why, Yu says there could be a number of factors.

"There's a possibility of under-diagnosis in women but also women have different co-existing conditions," said Yu, who's also a stroke neurologist. "In our study, women were more likely to have migraines and recent life stressors, and that can lead doctors down a different path."

Yu works at Sunnybrook Health Sciences Centre and as an assistant professor at University of Toronto.

Dr. Amy Yu, lead author of the study, says more research should look at why women are diagnosed with minor strokes less often than men. ( Kevin Van Paassen/ Sunnybrook Health Sciences Centre)

Implicit sex and gender bias may lead to doctors interpreting symptoms differently depending on the gender of the patient, as well, she said.

"There are a lot of potential reasons, and I think more research is needed in this area," she said.

Past research found women were more likely to report atypical symptoms of stroke, such as dizziness, confusion and headaches, she said, and were more likely to be diagnosed with something other than a stroke.

This study found atypical symptoms, which aren't as commonly associated with stroke, reported equally between the sexes.

Typical symptoms of stroke include facial drooping, speech problems and sudden weakness, particularly on one side of the body.

"What we found was actually women and men report very similar symptoms," said Yu. "But in our study, women were still less likely to be diagnosed as a stroke."

She believes it's important to raise awareness about the less common symptoms of stroke.

About the Author

Jennifer Lee


Jennifer Lee is a CBC News reporter based in Calgary. She worked at CBC Toronto, Saskatoon and Regina, before landing in Calgary in 2002. If you have a health or human interest story to share, let her know.


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