Sex differences in diagnosis and diagnostic revision of suspected minor cerebral ischemic events

Yu AYX, Hill MD, Asdaghi N, Boulanger JM, Camden MC, Campbell BCV, Demchuk AM, Field TS, Goyal M, Krause M, Mandzia J, Menon BK, Mikulik R, Moreau F, Penn
AM, Swartz RH, Coutts SB; Diagnosis of Uncertain-Origin Benign Transient Neurological Symptoms (DOUBT) Study Group. 

Neurology. 2020 Nov 12:10.1212/WNL.0000000000011212. doi: 10.1212/WNL.0000000000011212. Epub
ahead of print. PMID: 33184228.

18 Nov 2020

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Objective: To describe sex differences in the presentation, diagnosis, and revision of diagnosis after early brain MRI in patients who present with acute transient or minor neurological events.

Methods: We performed a secondary analysis of a prospective multicenter cohort study of patients referred to neurology between 2010 and 2016 with a possible cerebrovascular event and evaluated with brain MRI within 8 days of symptom onset. Investigators documented the characteristics of the event, initial diagnosis, and final diagnosis. We used multivariable logistic regression analyses to evaluate the association between sex and outcomes.

Results: Among 1,028 patients (51% women, median age 63 years), more women than men reported headaches and fewer reported chest pain, but there were no sex differences in other accompanying symptoms. Women were more likely than men to be initially diagnosed with stroke mimic (54% of women versus 42% of men, adjusted odds ratio (OR) 1.60 CI95 [1.24,2.07]) and women were overall less likely to have ischemia on MRI (10% versus 17%, OR 0.52 CI95 [0.36,0.76]). Among 496 patients initially diagnosed with mimic, women were less likely than men to have their diagnosis revised to minor stroke or TIA (13% versus 20%, OR 0.53 CI95 [0.32,0.88]), but were equally likely to have acute ischemia on MRI (5% versus 8%, OR 0.56 CI95 [0.26,1.21]).

Conclusions: Stroke mimic was more frequently diagnosed in women than men, but diagnostic revisions were common in both. Early brain MRI is a useful addition to clinical evaluation in diagnosing transient or minor neurological events.

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