학술논문
Sex-specific lesion pattern of functional outcomes after stroke
Document Type
Author
Bonkhoff, A. K.; Bretzner, M.; Hong, S. M.; Schirmer, M. D.; Cohen, A.; Regenhardt, R. W.; Donahue, K. L.; Nardin, M. J.; Dalca, A. V.; Giese, A. K.; Etherton, M. R.; Hancock, B. L.; Mocking, S. J. T.; McIntosh, E. C.; Attia, J.; Benavente, O. R.; Bevan, S.; Cole, J. W.; Donatti, A.; Griessenauer, C. J.; Heitsch, L.; Holmegaard, Lukas; Jood, Katarina, 1966; Jimenez-Conde, J.; Kittner, S. J.; Lemmens, R.; Levi, C. R.; McDonough, C. W.; Meschia, J. F.; Phuah, C. L.; Rolfs, A.; Ropele, S.; Rosand, J.; Roquer, J.; Rundek, T.; Sacco, R. L.; Schmidt, R.; Sharma, P.; Slowik, A.; Soderholm, M.; Sousa, A.; Stanne, Tara M, 1979; Strbian, D.; Tatlisumak, Turgut; Thijs, V.; Vagal, A.; Wasselius, J.; Woo, D.; Zand, R.; McArdle, P. F.; Worrall, B. B.; Jern, Christina, 1962; Lindgren, A. G.; Maguire, J.; Fox, M. D.; Bzdok, D.; Wu, O. N.; Rost, N. S.
Source
Brain Communications. 4(2)
Subject
Language
English
ISSN
2632-1297
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. 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.