{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T22:30:12Z","timestamp":1791757812566,"version":"4.3.4"},"reference-count":79,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T00:00:00Z","timestamp":1643673600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Purpose:<\/jats:title>\n                    <jats:p>Women have worse outcomes than men after stroke. Differences in presentation may lead to misdiagnosis and, in part, explain these disparities. We investigated whether there are sex differences in clinical presentation of acute stroke or transient ischemic attack.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Inclusion criteria were (1) cohort, cross-sectional, case-control, or randomized controlled trial design; (2) admission for (suspicion of) ischemic or hemorrhagic stroke or transient ischemic attack; and (3) comparisons possible between sexes in \u22651 nonfocal or focal acute stroke symptom(s). A random-effects model was used for our analyses. We performed sensitivity and subanalyses to help explain heterogeneity and used the Newcastle-Ottawa Scale to assess bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We included 60 studies (n=582\u2009844; 50% women). In women, headache (pooled odds ratio [OR], 1.24 [95% CI, 1.11\u20131.39]; I\n                      <jats:sup>2<\/jats:sup>\n                      =75.2%; 30 studies) occurred more frequently than in men with any type of stroke, as well as changes in consciousness\/mental status (OR, 1.38 [95% CI, 1.19\u20131.61]; I\n                      <jats:sup>2<\/jats:sup>\n                      =95.0%; 17 studies) and coma\/stupor (OR, 1.39 [95% CI, 1.25\u20131.55]; I\n                      <jats:sup>2<\/jats:sup>\n                      =27.0%; 13 studies). Aspecific or other neurological symptoms (nonrotatory dizziness and non-neurological symptoms) occurred less frequently in women (OR, 0.96 [95% CI, 0.94\u20130.97]; I\n                      <jats:sup>2<\/jats:sup>\n                      =0.1%; 5 studies). Overall, the presence of focal symptoms was not associated with sex (pooled OR, 1.03) although dysarthria (OR, 1.14 [95% CI, 1.04\u20131.24]; I\n                      <jats:sup>2<\/jats:sup>\n                      =48.6%; 11 studies) and vertigo (OR, 1.23 [95% CI, 1.13\u20131.34]; I\n                      <jats:sup>2<\/jats:sup>\n                      =44.0%; 8 studies) occurred more frequently, whereas symptoms of paresis\/hemiparesis (OR, 0.73 [95% CI, 0.54\u20130.97]; I\n                      <jats:sup>2<\/jats:sup>\n                      =72.6%; 7 studies) and focal visual disturbances (OR, 0.83 [95% CI, 0.70\u20130.99]; I\n                      <jats:sup>2<\/jats:sup>\n                      =62.8%; 16 studies) occurred less frequently in women compared with men with any type of stroke. Most studies contained possible sources of bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>There may be substantive differences in nonfocal and focal stroke symptoms between men and women presenting with acute stroke or transient ischemic attack, but sufficiently high-quality studies are lacking. More studies are needed to address this because sex differences in presentation may lead to misdiagnosis and undertreatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.120.034040","type":"journal-article","created":{"date-parts":[[2021,12,14]],"date-time":"2021-12-14T05:00:21Z","timestamp":1639458021000},"page":"345-354","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":105,"title":["Sex Differences in Presentation of Stroke: A Systematic Review and Meta-Analysis"],"prefix":"10.1161","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3409-7835","authenticated-orcid":true,"given":"Mariam","family":"Ali","sequence":"first","affiliation":[{"name":"Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.A., M.C.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8911-8608","authenticated-orcid":true,"given":"Hendrikus J.A.","family":"van Os","sequence":"additional","affiliation":[{"name":"Department of Neurology (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.), Leiden University Medical Center, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7700-274X","authenticated-orcid":true,"given":"Nelleke","family":"van der Weerd","sequence":"additional","affiliation":[{"name":"Department of Neurology (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.), Leiden University Medical Center, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1120-4781","authenticated-orcid":true,"given":"Jan W.","family":"Schoones","sequence":"additional","affiliation":[{"name":"Walaeus Library (J.W.S.), Leiden University Medical Center, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3889-0921","authenticated-orcid":true,"given":"Martijn W.","family":"Heymans","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, the Netherlands (M.W.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2320-0932","authenticated-orcid":true,"given":"Nyika D.","family":"Kruyt","sequence":"additional","affiliation":[{"name":"Department of Neurology (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.), Leiden University Medical Center, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke C.","family":"Visser","sequence":"additional","affiliation":[{"name":"Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.A., M.C.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6838-9521","authenticated-orcid":true,"given":"Marieke J.H.","family":"Wermer","sequence":"additional","affiliation":[{"name":"Department of Neurology (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.), Leiden University Medical Center, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000659"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2017.02.007"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2019.1305"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.106.478495"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.genm.2011.08.001"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.546812"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1159\/000082999"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0333102418767999"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.031510"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.015625"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30201-1"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2002.128682"},{"key":"e_1_3_2_15_2","article-title":"The Newcastle-Ottawa Scale (NOS) for Assessing The Quality of Nonrandomised Studies in Meta-analyses.","volume":"7","author":"Wells G","year":"2014","unstructured":"Wells, G, Shea, B, O\u2019Connell, J. 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