Sex-specific lesion pattern of functional outcomes after stroke-Reference-Cited by-同舟云学术

Sex-specific lesion pattern of functional outcomes after stroke

Published:2022-02-02 Issue:2 Volume:4 Page:
ISSN:2632-1297
Container-title:Brain Communications
language:en
Short-container-title:

Author:

Bonkhoff Anna K.¹,Bretzner Martin¹²^ORCID,Hong Sungmin¹,Schirmer Markus D.¹³,Cohen Alexander⁴⁵^ORCID,Regenhardt Robert W.¹,Donahue Kathleen L.¹,Nardin Marco J.¹,Dalca Adrian V.⁶⁷,Giese Anne-Katrin⁸,Etherton Mark R.¹^ORCID,Hancock Brandon L.⁷,Mocking Steven J. T.⁷,McIntosh Elissa C.⁷,Attia John⁹¹⁰,Benavente Oscar R.¹¹,Bevan Stephen¹²,Cole John W.¹³,Donatti Amanda¹⁴,Griessenauer Christoph J.¹⁵¹⁶,Heitsch Laura¹⁷¹⁸,Holmegaard Lukas¹⁹²⁰,Jood Katarina¹⁹²⁰^ORCID,Jimenez-Conde Jordi²¹,Kittner Steven J.¹³,Lemmens Robin²²²³^ORCID,Levi Christopher R.¹⁰²⁴,McDonough Caitrin W.²⁵,Meschia James F.²⁶,Phuah Chia-Ling¹⁸,Rolfs Arndt²⁷,Ropele Stefan²⁸,Rosand Jonathan¹⁷²⁹,Roquer Jaume²¹,Rundek Tatjana³⁰,Sacco Ralph L.³⁰,Schmidt Reinhold²⁸,Sharma Pankaj³¹³²,Slowik Agnieszka³³,Söderholm Martin³⁴³⁵,Sousa Alessandro¹⁴,Stanne Tara M.³⁶,Strbian Daniel³⁷^ORCID,Tatlisumak Turgut²⁰³⁸,Thijs Vincent³⁹⁴⁰,Vagal Achala⁴¹,Wasselius Johan⁴²⁴³,Woo Daniel⁴⁴,Zand Ramin⁴⁵,McArdle Patrick F.⁴⁶,Worrall Bradford B.⁴⁷⁴⁸,Jern Christina³⁶⁴⁹,Lindgren Arne G.⁵⁰⁵¹,Maguire Jane⁵²,Fox Michael D.⁴,Bzdok Danilo⁵³⁵⁴,Wu Ona⁵,Rost Natalia S.¹,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. T.,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,Rolfs Arndt,Ropele Stefan,Rosand Jonathan,Roquer Jaume,Rundek Tatjana,Sacco Ralph L.,Schmidt Reinhold,Sharma Pankaj,Slowik Agnieszka,Söderholm Martin,Sousa Alessandro,Stanne Tara M.,Strbian Daniel,Tatlisumak Turgut,Thijs Vincent,Vagal Achala,Wasselius Johan,Woo Daniel,Zand Ramin,McArdle Patrick F.,Worrall Bradford B.,Jern Christina,Lindgren Arne G.,Maguire Jane,Fox Michael D.,Bzdok Danilo,Wu Ona,Rost Natalia S.,

Affiliation:

1. J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

2. Univ. Lille, Inserm, CHU Lille, U1171—LilNCog (JPARC)—Lille Neurosciences & Cognition, Lille F-59000, France

3. Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany

4. Center for Brain Circuit Therapeutics, Department of Neurology, Psychiatry, and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

5. Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

6. Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Boston, MA, USA

7. Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA

8. Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

9. Hunter Medical Research Institute, Newcastle, NSW, Australia

10. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia

11. Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada

12. School of Life Sciences, University of Lincoln, Lincoln, UK

13. Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA

14. School of Medical Sciences, University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP, Brazil

15. Department of Neurosurgery, Geisinger, Danville, PA, USA

16. Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria

17. Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA

18. Department of Neurology, Washington University School of Medicine & Barnes-Jewish Hospital, St Louis, MO, USA

19. Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

20. Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden

21. Department of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d’Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain

22. Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven—University of Leuven, Leuven, Belgium

23. Department of Neurology, VIB, Vesalius Research Center, Laboratory of Neurobiology, University Hospitals Leuven, Leuven, Belgium

24. Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia

25. Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL, USA

26. Department of Neurology, Mayo Clinic, Jacksonville, FL, USA

27. Centogene AG, Rostock, Germany

28. Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria

29. Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA

30. Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA

31. Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK

32. St Peter’s and Ashford Hospital, Egham, UK

33. Department of Neurology, Jagiellonian University Medical College, Krakow, Poland

34. Department of Clinical Sciences Malmö, Lund University, Lund, Sweden

35. Department of Neurology, Skåne University Hospital, Lund and Malmö, Malmo, Sweden

36. Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

37. Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

38. Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

39. Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia

40. Department of Neurology, Austin Health, Heidelberg, Australia

41. Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

42. Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden

43. Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden

44. Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA

45. Department of Neurology, Geisinger, Danville, PA, USA

46. Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

47. Department of Neurology, University of Virginia, Charlottesville, VA, USA

48. Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA

49. Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden

50. Department of Neurology, Skåne University Hospital, Lund, Sweden

51. Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden

52. University of Technology Sydney, Sydney, Australia

53. Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, Faculty of Medicine, School of Computer Science, McGill University, Montreal, Canada

54. Mila—Quebec Artificial Intelligence Institute, Montreal, Canada

Abstract

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.

Funder

the Massachusetts General Hospital Executive Committee on Research

Medical Discovery

Clinical Research

National Institutes of Health and the National Institute of Neurological Disorders and Stroke

Swedish Research Council

Avtal om Läkarutbildning och Medicinsk Forskning

Swedish Heart and Lung Foundation

National Institutes of Health

Brain Canada Foundation

Canadian Institute of Health Research

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