Sex-specific lesion pattern of functional outcomes after stroke

Authors

• 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

Recommended Citation

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.; 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; and Rolfs, Arndt, "Sex-specific lesion pattern of functional outcomes after stroke" (2022). Neurology. 1733.
https://scholar.barrowneuro.org/neurology/1733