Shashank Shekhar, MD, MS

Gocan S, Fitzpatrick T, Wang CQ, Taljaard M, Cheng W, Bourgoin A, Dowlatshahi D, Stotts G, Shamy M. Diagnosis of Transient Ischemic Attack: Sex-Specific Differences From a Retrospective Cohort Study. Stroke. 2020.

Sex differences might play a role in TIA/stroke diagnosis. Men and women could have variable TIA/stroke symptom characteristics. Women especially have been reported to have non-specific and atypical symptoms, which can result in a wrong diagnosis or no diagnosis. However, stroke in women tends to have a more severe and complicated course. The recent study by Gocan et al., published in Stroke, attempts to determine the relationship between clinical variables associated with a neurologist’s final diagnosis of TIA/stroke and the patient’s sex difference.

The authors conducted a retrospective analysis of the patient cohort from the Ottawa Hospital Stroke prevention clinic in 2015. The study identified 23 character variables for TIA/stroke diagnosis. Out of that, 15 variables were used, and the remaining eight were excluded due to the low frequency of occurrences.

A total of 1770 patients with a mean age of 67.3 were studied. There were 50% of females in the cohort. The final diagnosis included definite TIA/stroke in 37%, possible TIA/stroke in 21%, and not TIA/stroke in 42%. The results showed no sign of sex-specific differences in unilateral weakness, aphasia, amaurosis fugax, homonymous hemianopia, headache, symptomatic carotid stenosis, 2 or more events, and stereotypes, dysarthria, or smoking.

The most significant sex-specific difference was noted in sudden vs. gradual onset of symptoms, with 66 times more odds in females for definite TIA/stroke diagnosis. The pain was rarely given definite TIA/stroke diagnosis (12%) in females vs. males (58%). Similarly, males received a more definite diagnosis of TIA/stroke for unilateral sensory loss than females. There was a sex-specific difference in symptom duration of ≥1 min vs. <1 min. The other difference was in age >60 years; females had higher odds of definite TIA/stroke diagnosis. 

Contrary to previous studies by Girjijala RL et al. 2017, and Jerath NU et al. 2011, which showed women had more generalized and non-traditional signs than men, this cohort study did not suggest such findings. The study had limitations because of the retrospective nature of the study design. Also, the study was not powered to detect the difference by gender.

Overall, this study highlights the sex difference in TIA/stroke’s final diagnosis based on common presenting symptoms. For clinicians, we should be watchful when evaluating stroke and TIA patients, mostly not to ignore minor symptoms in female patients.