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Bonkhoff, AK; Bretzner, M; Hong, S; Schirmer, MD; Cohen, A; Regenhardt, RW; Donahue, KL; Nardin, MJ; Dalca, AV; Giese, AK; Etherton, MR; Hancock, BL; Mocking, SJT; McIntosh, EC; Attia, J; Benavente, OR; Bevan, S; Cole, JW; Donatti, A; Griessenauer, CJ; Heitsch, L; Holmegaard, L; Jood, K; Jimenez-Conde, J; Kittner, SJ; Lemmens, R; Levi, CR; McDonough, CW; Meschia, JF; Phuah, CL; Rolfs, A; Ropele, S; Rosand, J; Roquer, J; Rundek, T; Sacco, RL; Schmidt, R; Sharma, P; Slowik, A; Söderholm, M; Sousa, A; Stanne, TM; Strbian, D; Tatlisumak, T; Thijs, V; Vagal, A; Wasselius, J; Woo, D; Zand, R; McArdle, PF; Worrall, BB; Jern, C; Lindgren, AG; Maguire, J; Fox, MD; Bzdok, D; Wu, O; Rost, NS, , MRI-GENIE, and, GISCOME, Investigators, and, the, International, Stroke, Genetics, Consortium, .
Sex-specific lesion pattern of functional outcomes after stroke.
Brain Commun. 2022; 4(2): fcac020 Doi: 10.1093/braincomms/fcac020 [OPEN ACCESS]
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Co-authors Med Uni Graz: Ropele Stefan; Schmidt Reinhold
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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.
Find related publications in this database (Keywords): acute ischaemic stroke; functional outcomes; sex differences; lesion patterns; Bayesian hierarchical modelling