Sex-specific lesion pattern of functional outcomes after stroke

Anna K. Bonkhoff, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Martin Bretzner, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Sungmin Hong, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Markus D. Schirmer, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Alexander Cohen, Center for Brain Circuit Therapeutics, Department of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Robert W. Regenhardt, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Kathleen L. Donahue, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Marco J. Nardin, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Adrian V. Dalca, Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Boston, MA, USA.
Anne-Katrin Giese, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Mark R. Etherton, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Brandon L. Hancock, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
Steven J. Mocking, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
Elissa C. McIntosh, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
John Attia, Hunter Medical Research Institute, Newcastle, NSW, Australia.
Oscar R. Benavente, Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada.
Stephen Bevan, School of Life Sciences, University of Lincoln, Lincoln, UK.
John W. Cole, Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA.
Amanda Donatti, School of Medical Sciences, University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP, Brazil.
Christoph J. Griessenauer, Department of Neurosurgery, Geisinger, Danville, PA, USA.
Laura Heitsch, Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA.
Lukas Holmegaard, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Katarina Jood, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Jordi Jimenez-Conde, Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain.
Steven J. Kittner, Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA.
Robin Lemmens, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium.
Christopher R. Levi, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
Caitrin W. McDonough, Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL, USA.
James F. Meschia, Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
Chia-Ling Phuah, Department of Neurology, Washington University School of Medicine & Barnes-Jewish Hospital, St Louis, MO, USA.
Arndt Rolfs, Centogene AG, Rostock, Germany.

Document Type

Article

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.

Publication Date

1-1-2022

Publication Title

Brain communications

E-ISSN

2632-1297

Volume

4

Issue

2

First Page

fcac020

PubMed ID

35282166

Digital Object Identifier (DOI)

10.1093/braincomms/fcac020

Link to Full Text

Share

COinS