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

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

doi:10.1038/s41467-021-23492-3

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

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

Western Sydney University

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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.

Original language	English
Article number	3289
Number of pages	14
Journal	Nature Communications
Volume	12
Issue number	1
DOIs	https://doi.org/10.1038/s41467-021-23492-3
Publication status	Published - 2021

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10.1038/s41467-021-23492-3

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Bonkhoff, A. K., Schirmer, M. D., Bretzner, M., Hong, S., Regenhardt, R. W., Brudfors, M., 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., ... Rost, N. S. (2021). Outcome after acute ischemic stroke is linked to sex-specific lesion patterns. Nature Communications, 12(1), Article 3289. https://doi.org/10.1038/s41467-021-23492-3

@article{17ec4534ae06491eb3ca1a68aa64d92b,

title = "Outcome after acute ischemic stroke is linked to sex-specific lesion patterns",

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.",

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

year = "2021",

doi = "10.1038/s41467-021-23492-3",

language = "English",

volume = "12",

journal = "Nature Communications",

issn = "2041-1723",

publisher = "Nature Publishing Group",

number = "1",

}

Bonkhoff, AK, Schirmer, MD, Bretzner, M, Hong, S, Regenhardt, RW, Brudfors, M, Donahue, KL, Nardin, MJ, Dalca, AV, Giese, A-K, 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, C-L, 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, Bzdok, D, Wu, O & Rost, NS 2021, 'Outcome after acute ischemic stroke is linked to sex-specific lesion patterns', Nature Communications, vol. 12, no. 1, 3289. https://doi.org/10.1038/s41467-021-23492-3

TY - JOUR

T1 - Outcome after acute ischemic stroke is linked to sex-specific lesion patterns

AU - Bonkhoff, Anna K.

AU - Schirmer, Markus D.

AU - Bretzner, Martin

AU - Hong, Sungmin

AU - Regenhardt, Robert W.

AU - Brudfors, Mikael

AU - Donahue, Kathleen L.

AU - Nardin, Marco J.

AU - Dalca, Adrian V.

AU - Giese, Anne-Katrin

AU - Etherton, Mark R.

AU - Hancock, Brandon L.

AU - Mocking, Steven J. T.

AU - McIntosh, Elissa C.

AU - Attia, John

AU - Benavente, Oscar R.

AU - Bevan, Stephen

AU - Cole, John W.

AU - Donatti, Amanda

AU - Griessenauer, Christoph J.

AU - Heitsch, Laura

AU - Holmegaard, Lukas

AU - Jood, Katarina

AU - Jimenez-Conde, Jordi

AU - Kittner, Steven J.

AU - Lemmens, Robin

AU - Levi, Christopher R.

AU - McDonough, Caitrin W.

AU - Meschia, James F.

AU - Phuah, Chia-Ling

AU - Rolfs, Arndt

AU - Ropele, Stefan

AU - Rosand, Jonathan

AU - Roquer, Jaume

AU - Rundek, Tatjana

AU - Sacco, Ralph L.

AU - Schmidt, Reinhold

AU - Sharma, Pankaj

AU - Slowik, Agnieszka

AU - Söderholm, Martin

AU - Sousa, Alessandro

AU - Stanne, Tara M.

AU - Strbian, Daniel

AU - Tatlisumak, Turgut

AU - Thijs, Vincent

AU - Vagal, Achala

AU - Wasselius, Johan

AU - Woo, Daniel

AU - Zand, Ramin

AU - McArdle, Patrick F.

AU - Worrall, Bradford B.

AU - Jern, Christina

AU - Lindgren, Arne G.

AU - Maguire, Jane

AU - Bzdok, Danilo

AU - Wu, Ona

AU - Rost, Natalia S.

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

UR - https://hdl.handle.net/1959.7/uws:64964

U2 - 10.1038/s41467-021-23492-3

DO - 10.1038/s41467-021-23492-3

M3 - Article

SN - 2041-1723

VL - 12

JO - Nature Communications

JF - Nature Communications

IS - 1

M1 - 3289

ER -

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

Abstract

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