Sex Differences in Presentation of Stroke

A Systematic Review and Meta-Analysis

Mariam Ali, BSc; Hendrikus J.A. van Os, MD; Nelleke van der Weerd, MSc; Jan W. Schoones, MA; Martijn W. Heymans, PhD; Nyika D. Kruyt, MD, PhD; Marieke C. Visser, MD, PhD; Marieke J.H. Wermer, MD, PhD


Stroke. 2022;53(2):345-354. 

In This Article


We found that women have a significant higher odds of presenting with nonfocal symptoms during acute stroke compared with men. Furthermore, significant sex differences were observed regarding focal stroke symptomatology. However, given the heterogeneity and poor methodological quality of our included studies, our findings should be considered as hypothesis generating. Additional research is required for more conclusive results. Future prospective cohort studies should be specifically designed to assess sex differences; should take confounding factors into account and adjust for at least age, stroke subtype, and comorbidity; and should report presenting nonfocal and focal symptoms by stroke subtype, timing, and location. Finally, studies need to assess the association between presenting symptoms and clinical diagnosis and should compare the symptoms of women and men with and without confirmed stroke to improve the diagnosis of stroke in clinical practice.