Sex-specific lesion pattern of functional outcomes after stroke

Anna K. Bonkhoff, Martin Bretzner, Sungmin Hong, Markus D. Schirmer, Alexander Cohen, Robert W. Regenhardt, 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, Michael D. Fox, Danilo Bzdok, Ona Wu, Natalia S. Rost

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


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.

Original languageEnglish
Article numberfcac020
JournalBrain Communications
Issue number2
StatePublished - 2022


  • Acute ischaemic stroke
  • Bayesian hierarchical modelling
  • Functional outcomes
  • Lesion patterns
  • Sex differences


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