Outcome after acute ischemic stroke is linked to sex-specific lesion patterns.

Natalia S Rost, Jordi Jimenez-Conde, Steven J Kittner, Christopher R Levi, Caitrin W McDonough, James F Meschia, Chia-Ling Phuah, Arndt Rolfs, Jonathan Rosand, Jaume Roquer, Tatjana Rundek, Ralph L Sacco, Achala Vagal, Daniel Woo, Ramin Zand, Laura Heitsch, Robin Lemmens, Turgut Tatlisumak, Bradford B Worrall, Anna K Bonkhoff, Martin Bretzner, Mikael Brudfors, Pankaj Sharma, Martin Söderholm, Tara M Stanne, Christina Jern, Jane Maguire, Danilo Bzdok, Ona Wu, Markus D Schirmer, Anne-Katrin Giese, Amanda Donatti, Lukas Holmegaard, Katarina Jood, Stefan Ropele, Reinhold Schmidt, Agnieszka Slowik, Alessandro Sousa, Daniel Strbian, Vincent Thijs, Johan Wasselius, Arne G Lindgren, Sungmin Hong, Patrick F McArdle, Robert W Regenhardt, Kathleen L Donahue, Marco J Nardin, Adrian V Dalca, Mark R Etherton, Brandon L Hancock, Steven J T Mocking, Elissa C McIntosh, John Attia, Oscar R Benavente, Stephen Bevan, John W Cole, Christoph J Griessenauer

Journal: Nature communications 2021;12(1):3289

PMID: 34078897

Abstract

Acute ischemic stroke affects men and women differently. In particular, women are often reported to experience higher acute stroke severity than men. We derived a low-dimensional representation of anatomical stroke lesions and designed a Bayesian hierarchical modeling framework tailored to estimate possible sex differences in lesion patterns linked to acute stroke severity (National Institute of Health Stroke Scale). This framework was developed in 555 patients (38% female). Findings were validated in an independent cohort (n = 503, 41% female). Here, we show brain lesions in regions subserving motor and language functions help explain stroke severity in both men and women, however more widespread lesion patterns are relevant in female patients. Higher stroke severity in women, but not men, is associated with left hemisphere lesions in the vicinity of the posterior circulation. Our results suggest there are sex-specific functional cerebral asymmetries that may be important for future investigations of sex-stratified approaches to management of acute ischemic stroke.

Address: J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. [email protected].; J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.; Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany.; Univ. Lille, Inserm, CHU Lille, U1171 - LilNCog (JPARC) - Lille Neurosciences & Cognition, F-59000, Lille, France.; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.; Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Boston, MA, USA.; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; Hunter Medical Research Institute, Newcastle, NSW, Australia.; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.; Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada.; School of Life Sciences, University of Lincoln, Lincoln, UK.; Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA.; School of Medical Sciences, University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Sao Paulo, Brazil.; Department of Neurosurgery, Geisinger, Danville, PA, USA.; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.; Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA.; Department of Neurology, Washington University School of Medicine & Barnes-Jewish Hospital, St Louis, MO, USA.; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.; Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain.; KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium.; VIB, Vesalius Research Center, Laboratory of Neurobiology, University Hospitals Leuven, Department of Neurology, Leuven, Belgium.; Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia.; Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL, USA.; Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.; Centogene AG, Rostock, Germany.; Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria.; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.; Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.; Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK.; St Peter's and Ashford Hospitals, Egham, UK.; Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.; Department of clinical sciences Malmö, Lund University, Lund, Sweden.; Department of Neurology, Skåne University Hospital, Lund and Malmö, Sweden.; Department of Laboratory Medicine, Institute of Biomedicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.; Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.; Department of Neurology, Austin Health, Heidelberg, Australia.; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.; Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden.; Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden.; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.; Department of Neurology, Geisinger, Danville, PA, USA.; Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.; Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, USA.; Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden.; Department of Neurology, Skåne University Hospital, Lund, Sweden.; Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.; University of Technology Sydney, Sydney, NSW, Australia.; Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, Faculty of Medicine, School of Computer Science, McGill University, Montreal, QC, Canada.; Mila - Quebec Artificial Intelligence Institute, Montreal, QC, Canada.
Bant logo

© Copyright 2026, Nutrition Evidence

NED wishes to thank the following organisations for their support:

We use cookies to improve your experience and analyze site traffic with Google Analytics. By continuing to use our site, you agree to our use of cookies. Learn more.