Sex-specific lesion pattern of functional outcomes after stroke. Issue 2 (2nd February 2022)

• Record Type: Journal Article
• Authors: Bonkhoff, Anna K.; Bretzner, Martin; Hong, Sungmin; Schirmer, Markus D.; Cohen, Alexander; Regenhardt, Robert W.; Donahue, Kathleen L.; Nardin, Marco J.; Dalca, Adrian V.; Giese, Anne-Katrin; Etherton, Mark R.; Hancock, Brandon L.; Mocking, Steven J. T.; McIntosh, Elissa C.; Attia, John; Benavente, Oscar R.; Bevan, Stephen; Cole, John W.; Donatti, Amanda; Griessenauer, Christoph J.; Heitsch, Laura; Holmegaard, Lukas; Jood, Katarina; Jimenez-Conde, Jordi; Kittner, Steven J.; Lemmens, Robin; Levi, Christopher R.; McDonough, Caitrin W.; Meschia, James F.; Phuah, Chia-Ling; Rolfs, Arndt; Ropele, Stefan; Rosand, Jonathan; Roquer, Jaume; Rundek, Tatjana; Sacco, Ralph L.; Schmidt, Reinhold; Sharma, Pankaj; Slowik, Agnieszka; Söderholm, Martin; Sousa, Alessandro; Stanne, Tara M.; Strbian, Daniel; Tatlisumak, Turgut; Thijs, Vincent; Vagal, Achala; Wasselius, Johan; Woo, Daniel; Zand, Ramin; McArdle, Patrick F.; Worrall, Bradford B.; Jern, Christina; Lindgren, Arne G.; Maguire, Jane; Fox, Michael D.; Bzdok, Danilo; Wu, Ona; Rost, Natalia S.;
• Is Part Of: Brain communications. Volume 4:Issue 2(2022)
• Publication Date: 2022-02-02
• Subjects: acute ischaemic stroke -- functional outcomes -- sex differences -- lesion patterns -- Bayesian hierarchical modelling; 616
• DOI: 10.1093/braincomms/fcac020
• Languages: English
• ISSNs: 2632-1297

Abstract

Abstract: Stroke represents a considerable burden of disease for both men and women. However, a growing body of literature suggests clinically relevant sex differences in the underlying causes, presentations and outcomes of acute ischaemic stroke. In a recent study, we reported sex divergences in lesion topographies: specific to women, acute stroke severity was linked to lesions in the left-hemispheric posterior circulation. We here determined whether these sex-specific brain manifestations also affect long-term outcomes. We relied on 822 acute ischaemic patients [age: 64.7 (15.0) years, 39% women] originating from the multi-centre MRI-GENIE study to model unfavourable outcomes (modified Rankin Scale >2) based on acute neuroimaging data in a Bayesian hierarchical framework. Lesions encompassing bilateral subcortical nuclei and left-lateralized regions in proximity to the insula explained outcomes across men and women (area under the curve = 0.81). A pattern of left-hemispheric posterior circulation brain regions, combining left hippocampus, precuneus, fusiform and lingual gyrus, occipital pole and latero-occipital cortex, showed a substantially higher relevance in explaining functional outcomes in women compared to men [mean difference of Bayesian posterior distributions (men – women) = −0.295 (90% highest posterior density interval = −0.556 to −0.068)]. Once validated in prospective studies, our findings may motivate a sex-specific approach to clinical stroke management and hold the promise of enhancing outcomes on a population level. Abstract : Relying on neuroimaging and clinical data of 822 acute stroke patients, Bonkhoff et al. report substantially more detrimental effects of lesions in left-hemispheric posterior circulation regions on functional outcomes in women compared to men. These findings may motivate a sex-specific clinical stroke management to improve outcomes in the longer term. Graphical Abstract: Graphical Abstract