Women may experience a stroke differently than men do, and often don’t complain of any classic symptoms at all. In fact, a study of more than 1,700 stroke patients found that women were 33% less likely than men to list one of the five conventional warning signs as their chief complaint.

Based on a statewide stroke registry in Michigan, the study was presented at the American Stroke Association’s annual meeting in San Francisco.

According to FDA guidelines, tissue plasminogen activator (tPA) must be given within three hours of symptom onset to effectively dissolve stroke-causing blood clots. If a triage clinician doesn’t recognize a stroke from a woman’s description, the patient may not be sent for tPA treatment soon enough.

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“We think that these differences between males and females in describing their complaint may help to explain treatment delays we’re seeing among female stroke patients in the ED,” said Julia W. Gargano, MS, of Michigan State University in East Lansing, who presented the findings.

None of the 1,724 people studied was immediately labeled as a stroke patient upon arrival in the ED, but all of them were ultimately diagnosed.

The American Heart Association’s traditional warning signs are:
• Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body.
• Sudden confusion, trouble speaking or understanding.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance or coordination.
• Sudden, severe headache with no known cause.

But 15% of the 931 women in the study and 10% of the 793 men didn’t report any of those signs, Gargano said. Instead, their most common complaints were:
• Loss of consciousness or fainting, with 60% of the 88 complaints coming from women.
• Respiratory complaints, 58% of 65 complaints from women.
• Falls or accidents, 63% of 32 complaints from women.
• Pain, 70% of 30 complaints from women.
• Seizures, 58% of 12 complaints from women.

Women were also 40% less likely than men to report difficulty with walking, balance, coordination, or dizziness. “These differences affect a relatively small number of people,” Gargano said, “but they may nevertheless have an impact on care.”