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Biological Mechanism of Sex Difference in Stroke Manifestation and Outcomes.
Ryu, Wi-Sun; Chung, Jinyong; Schellingerhout, Dawid; Jeong, Sang-Wuk; Kim, Hang-Rai; Park, Jung E; Kim, Beom Joon; Kim, Joon-Tae; Hong, Keun-Sik; Lee, Kyungbok; Park, Tai Hwan; Park, Sang-Soon; Park, Jong-Moo; Kang, Kyusik; Cho, Yong-Jin; Park, Hong-Kyun; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi Sun; Lee, Soo Joo; Kim, Jae Guk; Cha, Jae-Kwan; Kim, Dae-Hyun; Lee, Jun; Han, Moon-Ku; Park, Man Seok; Choi, Kang-Ho; Lee, Juneyoung; Bae, Hee-Joon; Kim, Dong-Eog.
Afiliação
  • Ryu WS; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Chung J; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Schellingerhout D; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Jeong SW; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Kim HR; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Park JE; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Kim BJ; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Kim JT; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Hong KS; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Lee K; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Park TH; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Park SS; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Park JM; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Kang K; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Cho YJ; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Park HK; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Lee BC; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Yu KH; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Oh MS; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Lee SJ; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Kim JG; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Cha JK; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Kim DH; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Lee J; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Han MK; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Park MS; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Choi KH; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Lee J; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Bae HJ; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
  • Kim DE; From the Department of Neurology (W.-S.R., S.-W.J., H.-R.K., J.E.P., D.-E.K.), Dongguk University Ilsan Hospital; National Priority Research Center for Stroke (W.-S.R., J.C., D.-E.K.), Goyang, South Korea; Departments of Neuroradiology and Imaging Physics (D.S.), University of Texas MD Anderson Canc
Neurology ; 100(24): e2490-e2503, 2023 06 13.
Article em En | MEDLINE | ID: mdl-37094993
ABSTRACT
BACKGROUND AND

OBJECTIVES:

Female patients tend to have greater disability and worse long-term outcomes after stroke than male patients. To date, the biological basis of sex difference in ischemic stroke remains unclear. We aimed to (1) assess sex differences in clinical manifestation and outcomes of acute ischemic stroke and (2) investigate whether the sex disparity is due to different infarct locations or different impacts of infarct in the same location.

METHODS:

This MRI-based multicenter study included 6,464 consecutive patients with acute ischemic stroke (<7 days) from 11 centers in South Korea (May 2011-January 2013). Multivariable statistical and brain mapping methods were used to analyze clinical and imaging data collected prospectively admission NIH Stroke Scale (NIHSS) score, early neurologic deterioration (END) within 3 weeks, modified Rankin Scale (mRS) score at 3 months, and culprit cerebrovascular lesion (symptomatic large artery steno-occlusion and cerebral infarction) locations.

RESULTS:

The mean (SD) age was 67.5 (12.6) years, and 2,641 (40.9%) were female patients. Percentage infarct volumes on diffusion-weighted MRI did not differ between female patients and male patients (median 0.14% vs 0.14%, p = 0.35). However, female patients showed higher stroke severity (NIHSS score, median 4 vs 3, p < 0.001) and had more frequent END (adjusted difference 3.5%; p = 0.002) than male patients. Female patients had more frequent striatocapsular lesions (43.6% vs 39.8%, p = 0.001) and less frequent cerebrocortical (48.2% vs. 50.7% in patients older than 52 years, p = 0.06) and cerebellar (9.1% vs. 11.1%, p = 0.009) lesions than male patients, which aligned with angiographic

findings:

female patients had more prevalent symptomatic steno-occlusion of the middle cerebral artery (MCA) (31.1% vs 25.3%; p < 0.001) compared with male patients, who had more frequent symptomatic steno-occlusion of the extracranial internal carotid artery (14.2% vs 9.3%; p < 0.001) and vertebral artery (6.5% vs 4.7%; p = 0.001). Cortical infarcts in female patients, specifically left-sided parieto-occipital regions, were associated with higher NIHSS scores than expected for similar infarct volumes in male patients. Consequently, female patients had a higher likelihood of unfavorable functional outcome (mRS score >2) than male patients (adjusted absolute difference 4.5%; 95% CI 2.0-7.0; p < 0.001).

DISCUSSION:

Female patients have more frequent MCA disease and striatocapsular motor pathway involvement with acute ischemic stroke, along with left parieto-occipital cortical infarcts showing greater severity for equivalent infarct volumes than in male patients. This leads to more severe initial neurologic symptoms, higher susceptibility to neurologic worsening, and less 3-month functional independence, when compared with male patients.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral / AVC Isquêmico Tipo de estudo: Clinical_trials / Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male Idioma: En Revista: Neurology Ano de publicação: 2023 Tipo de documento: Article
Texto completo
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral / AVC Isquêmico Tipo de estudo: Clinical_trials / Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male Idioma: En Revista: Neurology Ano de publicação: 2023 Tipo de documento: Article