Sex-Related Differences in Patients Treated Surgically for Aneurysmal Subarachnoid Hemorrhage

Horiuchi, Tetsuyoshi; Tanaka, Yuichiro; Hongo, Kazuhiro

doi:10.2176/nmc.46.328

Cited by 27 publications

(19 citation statements)

References 17 publications

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“…It is involved in the formation and rupture of cerebral aneurysm and subsequent SAH (57, 58). The peak incidence of aneurysmal SAH occurs in the 7 th decade in women and the 6 th decade in men (59). Estrogen deficiency, such as after menopause, is associated with increased risk for SAH (60) and hormone replacement therapy is associated with decreased risk SAH as well as ameliorating subsequent brain injury (52, 58, 61).…”

Section: Discussionmentioning

confidence: 99%

MRI Characterization in the Acute Phase of Experimental Subarachnoid Hemorrhage

Guo

Wilkinson

Thompson

et al. 2016

Transl. Stroke Res.

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A number of mechanisms have been proposed for the early brain injury after subarachnoid hemorrhage (SAH). In this study, we investigated the radiographic characteristics and influence of gender on early brain injury after experimental SAH. SAH was induced by endovascular perforation in male and female rats. Magnetic resonance imaging was performed in a 7.0-T Varian MR scanner at 24 hours after SAH. The occurrence and size of T2 lesions, ventricular dilation and white matter injury (WMI) was determined on T2 weighted images (T2WI). The effects of SAH on heme oxygenase-1 and fibrin/fibrinogen were examined by Western blotting and immunohistochemistry. SAH severity was assessed using a MRI grading system and neurological function was evaluated according to a modified Garcia’s scoring system. T2-hyperintensity areas and enlarged ventricles were observed in T2WI coronal sections 24 hours after SAH. The overall incidence of T2-lesions, WMI and hydrocephalus was 54, 20 and 63%, respectively. Female rats had a higher incidence of T2-hyperintensity lesions and hydrocephalus, as well as larger T2 lesion volumes and higher average ventricular volume. SAH rats graded at 3-4 (our previously validated MRI grading scale) had larger T2 lesion volumes, more hydrocephalus and worse neurological function compared with those graded at 0-2. In conclusion, T2-lesion, WMI and hydrocephalus were the most prevalent MRI characteristics 24 hours after experimental SAH. The T2-lesion area matched with fibrinogen/fibrin positive staining in the acute phase of SAH. SAH induced more severe brain injury in females compared to males in the acute phase of SAH.

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Section: Discussionmentioning

confidence: 99%

MRI Characterization in the Acute Phase of Experimental Subarachnoid Hemorrhage

Guo

Wilkinson

Thompson

et al. 2016

Transl. Stroke Res.

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“…For example, aneurysm prevalence varies between genders and hemispheres (Horiuchi et al, 2006), and sharply increases after the age of 50 (Wardlaw and White, 2000). We measured an extensive battery of global and local morphological properties, from the entire vascular arbors to individual arterial branches, including but not limited to size, distances, and angles.…”

Section: Discussionmentioning

confidence: 99%

Digital reconstruction and morphometric analysis of human brain arterial vasculature from magnetic resonance angiography

et al. 2013

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Characterization of the complex branching architecture of cerebral arteries across a representative sample of the human population is important for diagnosing, analyzing, and predicting pathological states. Brain arterial vasculature can be visualized by magnetic resonance angiography (MRA). However, most MRA studies are limited to qualitative assessments, partial morphometric analyses, individual (or small numbers of) subjects, proprietary datasets, or combinations of the above limitations. Neuroinformatics tools, developed for neuronal arbor analysis, were used to quantify vascular morphology from 3 T time-of-flight MRA high-resolution (620 μm isotropic) images collected in 61 healthy volunteers (36/25 F/M, average age = 31.2 ± 10.7, range = 19–64 years). We present in-depth morphometric analyses of the global and local anatomical features of these arbors. The overall structure and size of the vasculature did not significantly differ across genders, ages, or hemispheres. The total length of the three major arterial trees stemming from the circle of Willis (from smallest to largest: the posterior, anterior, and middle cerebral arteries; or PCAs, ACAs, and MCAs, respectively) followed an approximate 1:2:4 proportion. Arterial size co-varied across individuals: subjects with one artery longer than average tended to have all other arteries also longer than average. There was no net right–left difference across the population in any of the individual arteries, but ACAs were more lateralized than MCAs. MCAs, ACAs, and PCAs had similar branch-level properties such as bifurcation angles. Throughout the arterial vasculature, there were considerable differences between branch types: bifurcating branches were significantly shorter and straighter than terminating branches. Furthermore, the length and meandering of bifurcating branches increased with age and with path distance from the circle of Willis. All reconstructions are freely distributed through a public database to enable additional analyses and modeling (cng.gmu.edu/brava).

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“…Prior studies have documented higher rates of SAH in women compared to men(4). Differences in hypertension, smoking, and alcohol use as well as the involvement of estrogen have been suggested as possible explanations of the gender disparity in SAH(16). Further studies are warranted to examine the gender disparities and potential gender/ethnicity interaction in SAH.…”

Section: Discussionmentioning

confidence: 99%

Gender and ethnic differences in subarachnoid hemorrhage

Eden¹,

Meurer²,

Sánchez³

et al. 2008

Neurology

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Background and Purpose Mexican Americans (MAs) comprise the largest component of the largest minority group within the United States. The purpose of this study was to examine ethnic and gender differences in the epidemiology, presentation and outcomes after subarachnoid hemorrhage (SAH) in a representative United States community. Targeted public health interventions are dependent on accurate assessments of groups at highest disease risk. Methods All non-traumatic SAH patients older than 44 years were prospectively identified from January 1, 2000 to December 31, 2006 as part of the Brain Attack Surveillance In Corpus Christi (BASIC) project, an urban population-based study in southeast Texas. Risk ratios for cumulative SAH incidence comparing MAs with non Hispanic whites (NHWs), and women with men were calculated. Descriptive statistics for other clinical and demographic variables were computed overall, by gender and by ethnicity. Results A total of 107 patients had a SAH during the time period (seven-year cumulative incidence: 11/10,000); of these, 43 were NHW (40% of cases vs. 53% of the population) and 64 were MA (60% of cases vs. 48% of the population). The overall age-adjusted risk ratio for SAH in MAs compared with NHWs was 1.67 (95% CI: 1.13, 2.47), and in women compared to men was 1.74 (95% CI 1.16, 2.62). Overall in-hospital mortality was 32.2%. No ethnic difference was observed for discharge disability or in-hospital mortality. Conclusions SAH disproportionately affects MAs and women. Public health interventions should target these groups to reduce the impact of this severe disease.

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Sex-Related Differences in Patients Treated Surgically for Aneurysmal Subarachnoid Hemorrhage

Cited by 27 publications

References 17 publications

MRI Characterization in the Acute Phase of Experimental Subarachnoid Hemorrhage

MRI Characterization in the Acute Phase of Experimental Subarachnoid Hemorrhage

Digital reconstruction and morphometric analysis of human brain arterial vasculature from magnetic resonance angiography

Gender and ethnic differences in subarachnoid hemorrhage

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