Sex-specific lesion pattern of functional outcomes after stroke
Bonkhoff, Anna K. (J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School)
Bretzner, Martin (Univ. Lille)
Hong, Sungmin (Massachusetts General Hospital (Boston))
Schirmer, Markus D. (University Hospital Bonn (Bonn, Alemanya))
Cohen, Alexander (Boston Children's Hospital (Boston, Estats Units d'Amèrica))
Regenhardt, Robert W. (Massachusetts General Hospital (Boston))
Donahue, Kathleen L. (Massachusetts General Hospital (Boston))
Nardin, Marco J. (Massachusetts General Hospital (Boston))
Dalca, Adrian Vasile (Massachusetts General Hospital (Boston))
Giese, Anne-Katrin (University Medical Center Hamburg-Eppendorf)
Etherton, Mark R. (Massachusetts General Hospital (Boston))
Hancock, Brandon L. (Massachusetts General Hospital (Boston))
Mocking, Steven J. T. (Massachusetts General Hospital (Boston))
McIntosh, Elissa C. (Massachusetts General Hospital (Boston))
Attia, John (University of Newcastle)
Benavente, Oscar R. (University of British Columbia)
Bevan, Stephen (University of Lincoln)
Cole, John W. (University of Maryland School of Medicine)
Donatti, Amanda (University of Campinas)
Griessenauer, Christoph J. (Paracelsus Medical University)
Heitsch, Laura (Washington University School)
Holmegaard, Lukas (Sahlgrenska University Hospital (Suècia))
Jood, Katarina (Sahlgrenska University Hospital (Suècia))
Jimenez-Conde, Jordi (Institut Hospital del Mar d'Investigacions Mèdiques)
Kittner, Steven J. (University of Maryland)
Lemmens, Robin (University Hospitals Leuven (Bèlgica))
Levi, Christopher R. (John Hunter Hospital)
McDonough, Caitrin W. (University of Florida)
Meschia, James F. (Mayo Clinic (Jacksonville, Estats Units d'Amèrica))
Phuah, Chia-Ling (Washington University School of Medicine)
Rolfs, Arndt (Centogene AG)
Ropele, Stefan (Medical University Graz)
Rosand, Jonathan (Massachusetts General Hospital (Boston))
Roquer, Jaume (Institut Hospital del Mar d'Investigacions Mèdiques)
Rundek, Tatjana (University of Miami)
Sacco, Ralph L. (University of Miami. Miller School of Medicine)
Schmidt, Reinhold (Medical University Graz)
Sharma, Pankaj (St Peter's and Ashford Hospital)
Slowik, Agnieszka (Jagiellonian University Medical College)
Söderholm, Martin (Skåne University Hospital (Suècia))
Sousa, Alessandro (University of Campinas)
Stanne, Tara M. (University of Gothenburg)
Strbian, Daniel (Helsinki University Hospital)
Tatlisumak, Turgut (Sahlgrenska Academy at University of Gothenburg)
Thijs, Vincent (Austin Health)
Vagal, Achala (University of Cincinnati College of Medicine)
Wasselius, Johan (Skåne University Hospital (Suècia))
Woo, Daniel (University of Cincinnati College of Medicine)
Zand, Ramin (Department of Neurology, Geisinger)
McArdle, Patrick F. (University of Maryland School of Medicine)
Worrall, Bradford B. (University of Virginia)
Jern, Christina (Sahlgrenska University Hospital (Suècia))
Lindgren, Arne G. (Lund University)
Maguire, Jane (University of Technology Sydney)
Fox, Michael D. (Brigham and Women's Hospital (Boston, Estats Units d'Amèrica))
Bzdok, Danilo (Mila-Quebec Artificial Intelligence Institute)
Wu, Ona (Boston Children's Hospital (Boston, Estats Units d'Amèrica))
Rost, Natalia S. (Massachusetts General Hospital (Boston))
Universitat Autònoma de Barcelona

Fecha:	2022
Resumen:	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. 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.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Acute ischaemic stroke ; Functional outcomes ; Sex differences ; Lesion patterns ; Bayesian hierarchical modelling
Publicado en:	Brain Communications, Vol. 4 (february 2022) , ISSN 2632-1297

DOI: 10.1093/braincomms/fcac020
PMID: 35282166

12 p, 1.9 MB

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