# Sex differences in cerebral infarction in Norway: Analysis of data from the Norwegian Stroke Registry 2018–2022

## TL;DR

The study examines sex differences in stroke symptoms and treatment times in Norway, finding some variations in symptom presentation but overall sex equality in treatment timing.

## Contribution

The study provides new insights into sex differences in cerebral infarction symptoms and treatment delays in Norway using registry data.

## Key findings

- Women presented more often with FAST symptoms and specific neurological deficits like aphasia and neglect.
- Men were more likely to present with ataxia and double vision.
- Women had higher NIHSS scores and longer delays in seeking emergency medical help.

## Abstract

Whether sex influence the clinical pathway of stroke, has been debated. In this study, we want to compare and add knowledge to presentation of symptoms and time to treatment of cerebral infarction in men and women.

Data on 38,489 patients with cerebral infarction from 2018 to 2022 were obtained from the Norwegian Stroke Registry (NHR). The analyses were stratified by sex and age groups.

Overall, there was a substantial sex parity for both focal neurological deficits and time to treatment. However, women were less likely to be awake at admission (RR 0.96, CI 0.95–0.97). A higher proportion of women presented with FAST symptoms (RR 1.06, CI 1.04–1.07), and women presented more often with arm paresis (RR 1.11, CI 1.08–1.14), facial paresis (RR 1.08, CI 1.05–1.11), aphasia (RR 1.17, CI 1.13–1.21), leg paresis (RR 1.18, CI 1.15–1.21) and neglect (RR 1.24, CI 1.18–1.31). Men presented more often with ataxia (RR 0.85, CI 0.81–0.89) and double vision (RR 0.72, CI 0.64–0.81). At admission, women had significantly higher National Institutes of Health Stroke Scale (NIHSS) score compared to men (average 5.60 vs 4.66), and significantly longer time from symptom onset to notification of Emergency Medical Communication Center (EMCC; average 298 vs 282 min)

Our findings indicate a large degree of sex equality in terms of symptoms and time to treatment for Norwegian patients with cerebral infarction. Further research exploring possible sex disparity in stroke treatment, is warranted.

Graphical Abstract