There's a gender split in mini-stroke diagnosis

Women are less likely to be diagnosed with a mini-stroke than men, and researchers are trying to figure out why.

A mini-stroke, also known as a transient ischemic attack or TIA, usually doesn't last long or cause permanent damage. But it still requires medical attention, because it may be a warning of a future stroke that can have dire consequences.

Appropriate diagnosis is crucial, so the gender disparity is concerning. Studies have also found differences in the way men and women are treated for heart attack and in CPR emergencies.

"Unlike a heart attack, the diagnosis of TIA doesn't depend on a biomarker or a diagnostic test where you can definitely say this occurred," said Sophia Gocan, a stroke prevention nurse specialist at The Ottawa Hospital in Canada. She was lead author of the relevant study.

"It really relies on a stroke specialist's expertise to say if this was a concerning event," Gocan said. "That's important because the specialist's decision determines whether that patient is going to go on to have different diagnostic tests or be prescribed therapies to prevent a stroke."

Stroke is the fifth-leading cause of death in the United States, killing nearly 150,000 people each year, and is a major cause of disability for those who survive. It occurs when the blood supply to the brain is interrupted, either by an artery that is blocked or ruptures. In a TIA, the blockage is only temporary, so some people may not notice it or ignore the dangers.
But the symptoms are the same, including numbness, severe headache, confusion, slurred speech and dizziness.

The researchers examined the records of 1,770 patients referred to The Ottawa Hospital Stroke Prevention Clinic in 2015 to see if men and women reporting common symptoms were diagnosed differently.

While many of the symptoms led to the same diagnosis in both men and women, the Ottawa study found several gender-specific differences.

Women over age 60 who reported a sudden onset of symptoms or an event lasting more than one minute were more likely than men to be diagnosed with TIA or stroke. But men who reported pain or sensory loss, such as trouble seeing, were more likely to receive the diagnosis than women.

"We know this is really just scratching the surface," Gocan said. "Maybe this is an indication that women need to use certain keywords when they're talking about their diagnosis to be taken as seriously, or maybe women and men describe their symptoms differently."

One factor in the disparity, Gocan said, could be that migraine headaches are more common among women. That might make women less likely to suspect a headache is signaling a TIA or stroke – or doctors more likely to consider a woman's headache a migraine.

"We've (medically) treated men and women the same for so many years," she said. "We need to make sure we're not painting everyone with the same brush when they may need a different approach."

Dr. Karen Furie, chair of neurology at the Alpert Medical School of Brown University in Providence, Rhode Island, agreed and said the responsibility lies with both doctors and patients.
"If you have sudden onset of symptoms that can't be explained by something else, patients should ask if this could have been a TIA or stroke, and not be comfortable until the clinicians have been able to rule that out," Furie said.