BACKGROUND AND PURPOSE: In a recent meta-analysis, women with stroke had 30% lower odds of receiving tissue plasminogen activator than did men, and some studies have reported greater in-hospital delays in women with stroke. Causes of these disparities are unclear but could result from a different symptom presentation in women. Our objective was to prospectively investigate gender differences in acute stroke symptoms. METHODS: Ischemic stroke/TIA cases presenting to the University of Michigan Hospital (January 2005 to December 2007) were identified. Stroke/TIA symptoms, ascertained by patient interview, were classified as traditional or nontraditional (pain, mental status change, lightheadedness, headache, other neurological, nonneurological). Prevalence of any nontraditional symptom and of each symptom were calculated by gender. Logistic regression was used to compare nontraditional symptoms by gender adjusted for stroke vs TIA, proxy use, age, and discharge disposition (home vs other). RESULTS: Included were 461 cases (48.6% women; median age, 67). Among women, 51.8% reported >or=1 nontraditional stroke/TIA symptom compared to 43.9% of men (P=0.09). The most prevalent nontraditional symptom was mental status change (women, 23.2%; men, 15.2%; P=0.03). The odds of reporting at least 1 nontraditional stroke/TIA symptom were 1.42 times (95% CI, 0.97-2.06) greater in women than in men. CONCLUSIONS: A high prevalence of nontraditional symptoms among both genders was found, with women more likely to report nontraditional symptoms and, in particular, altered mental status, compared with men. Larger-scale studies focusing on stroke in women are warranted and could confirm gender differences in symptoms in a larger, more representative stroke population and address the clinical consequences.