Gender disparities in stroke symptom presentation have been demonstrated, which can lead to delayed or missed opportunities for acute intervention. We have previously shown that our center is highly accurate in diagnosing ischemic stroke/TIA versus stroke mimics via telestroke, and that female gender was associated with misdiagnosis. There is limited data regarding gender disparities in ischemic stroke/TIA misdiagnosis.

We conducted a retrospective study of all telestroke consultations at our center between April 2015 and April 2016. Initial and final diagnoses were determined for all cases. To determine initial diagnosis deriving misdiagnoses, only patients with a misdiagnosis were analysed to investigate difference between gender in initial diagnosis. Fisher’s Exact test and Mann-Whitney test were used for analysis.

A total of 874 telestroke consultations were evaluated. In 209 (23.9%) patients, the initial and final diagnoses were discordant. Within misdiagnosed stroke/TIA patients (n=117), there was a significant difference between gender in initial diagnosis (p=0.0052). Females were more likely than males to be given an “uncertain” diagnosis (44.07% vs 17.24%). NIHSS was not statistically different between genders (p=0.6631). There were no statistically significant differences between males and females misdiagnosed with other stroke mimics and no gender differences in misdiagnosed patients with a final diagnosis of “uncertain".

This study demonstrates gender differences in misdiagnosis of ischemic stroke/TIA via telestroke consultation and that females are more likely to have an uncertain initial diagnosis. Potential explanations include gender bias and gender-specific differences in stroke signs and/or symptoms. Further study is warranted.