Women and Stroke: Different, yet Similar

Abstract

<b><i>Background:</i></b> The impact of gender on acute ischemic stroke, in terms of presentation, severity, etiology, and outcome, is increasingly getting recognized. Here, we analyzed the gender-related differences in etiology and outcome of ischemic stroke in South India. <b><i>Methods:</i></b> Patients with first ever ischemic stroke within 1 week of onset presenting to the Comprehensive Stroke Care Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India, were included in our study. Clinical and risk factor profile was documented. The stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at onset, and stroke subtype classification was done using Trial of Org 10172 in Acute Ischemic Stroke criteria. The 3-month functional outcome was assessed using the modified Rankin Scale (mRS) with excellent outcome defined as an mRS ≤2. <b><i>Results:</i></b> Of the 742 patients, 250 (33.7%) were females. The age, clinical profile, and rate of reperfusion therapies did not differ between the genders. Women suffered more severe strokes (mean NIHSS 9.5 vs. 8.4, <i>p</i> = 0.03). While large artery atherosclerosis was more common in men (21.3% vs. 14.8%, <i>p</i> = 0.03), cardioembolic strokes secondary to rheumatic heart disease were more common in women (27.2% vs. 19.7%, <i>p</i> = 0.02). Men had a better 3-month functional outcome compared to women (68.6% vs. 61.2%, <i>p</i> = 0.04), but was not statistically significant after adjusting for confounders. <b><i>Conclusion:</i></b> Our data, from a single comprehensive stroke unit from South India, suggest that stroke in women are different, yet similar in many ways to men. Guideline-based treatment can result in comparable short-term outcomes, irrespective of admission stroke severity.

Clinical Outcome of Stroke Patients Based on the National Institutes of Health Stroke Scale (Nihss) in a Tertiary Hospital

“…13 Then, according to the NIHSS, this study shows that moderate and severe strokes are more common in women, and mild strokes are more common in men. This study is consistent with the findings in a study conducted by Nandini Mitta et al 14 in India, which showed that the NIHSS scores in women tended to be higher than men with a mean ratio of 9.5 vs. 8.4. These findings can be explained because brain aging in women is more sensitive to ischemic events related to hormonal changes, primarily by decreased of estrogen, which causes changes in lipid profiles, insulin, increased blood pressure, and inflammatory and fibrinolytic markers contributing to the formation of atherosclerotic plaques.…”

“…The neurological deficit as a clinical outcome was assessed using the NIHSS during admission and discharge from the hospital with the following classifications: mild (≤6), moderate (7)(8)(9)(10)(11)(12)(13)(14)(15), and severe (≥16). 6,8 The data that has been collected is processed and analyzed using descriptive statistics.…”

COVID-19 Pandemic Brings Challenges to the Management of Stroke—The Differences Between Stroke Cases Admitted to a Tertiary Hospital Before and During COVID-19 Pandemic in China

“…The impact of gender on acute ischemic stroke, in terms of presentation, severity, etiology, and outcome, is increasingly getting recognized. 41 Therefore, Results of our research and previous researches indicate that COVID-19 is likely to have different effects on stroke patients of different gender. However, it is difficult to explain the gender difference in the impact of COVID-19 on stroke patients which were found in our study.…”

Expert Consensus on Improving Stroke Care Ecosystem in India

“…Men were more prone to large artery atherosclerosis, whereas women were more likely to develop cardioembolic strokes due to rheumatic heart disease. 6 As per the Hyderabad stroke registry, the pattern of ischemic stroke subtypes in India is similar to registries from West and East Asian countries. The registry indicates a significant occurrence of large artery and small vessel diseases, with intracranial atherosclerosis being the most prevalent.…”