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Stroke. 2017 Dec;48(12):3387-3389. doi: 10.1161/STROKEAHA.117.019258. Epub 2017 Nov 10.

Structural Integrity of Normal Appearing White Matter and Sex-Specific Outcomes After Acute Ischemic Stroke.

Author information

1
From the Department of Neurology, JPK Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.); Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (O.W.) and Division of Neurocritical Care and Emergency Neurology, Department of Neurology and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Boston; and Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.L.F.). metherton@partners.org.
2
From the Department of Neurology, JPK Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.); Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (O.W.) and Division of Neurocritical Care and Emergency Neurology, Department of Neurology and Center for Human Genetic Research (J.R.), Massachusetts General Hospital, Boston; and Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.L.F.).

Abstract

BACKGROUND AND PURPOSE:

Women have worse poststroke outcomes than men. We evaluated sex-specific clinical and neuroimaging characteristics of white matter in association with functional recovery after acute ischemic stroke.

METHODS:

We performed a retrospective analysis of acute ischemic stroke patients with admission brain MRI and 3- to 6-month modified Rankin Scale score. White matter hyperintensity and acute infarct volume were quantified on fluid-attenuated inversion recovery and diffusion tensor imaging MRI, respectively. Diffusivity anisotropy metrics were calculated in normal appearing white matter contralateral to the acute ischemia.

RESULTS:

Among 319 patients with acute ischemic stroke, women were older (68.0 versus 62.7 years; P=0.004), had increased incidence of atrial fibrillation (21.4% versus 12.2%; P=0.04), and lower rate of tobacco use (21.1% versus 35.9%; P=0.03). There was no sex-specific difference in white matter hyperintensity volume, acute infarct volume, National Institutes of Health Stroke Scale, prestroke modified Rankin Scale score, or normal appearing white matter diffusivity anisotropy metrics. However, women were less likely to have an excellent outcome (modified Rankin Scale score <2: 49.6% versus 67.0%; P=0.005). In logistic regression analysis, female sex and the interaction of sex with fractional anisotropy, radial diffusivity, and axial diffusivity were independent predictors of functional outcome.

CONCLUSIONS:

Female sex is associated with decreased likelihood of excellent outcome after acute ischemic stroke. The correlation between markers of white matter integrity and functional outcomes in women, but not men, suggests a potential sex-specific mechanism.

KEYWORDS:

brain ischemia; diffusion-weighted imaging; leukoaraiosis; stroke; white matter

PMID:
29127272
PMCID:
PMC5726524
DOI:
10.1161/STROKEAHA.117.019258
[Indexed for MEDLINE]
Free PMC Article

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