Age-Dependent Radiographic Vasospasm and Delayed Cerebral Ischemia in Women After Aneurysmal Subarachnoid Hemorrhage

• Published in: World neurosurgery 2019-10, Vol.130, p.e230-e235
• Main Authors: Lai, Pui Man Rosalind, Gormley, William B, Patel, Nirav, Frerichs, Kai U, Aziz-Sultan, M Ali, Du, Rose
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Brain Ischemia - diagnostic imaging; Brain Ischemia - etiology; Female; Humans; Male; Middle Aged; Retrospective Studies; Sex Characteristics; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - diagnostic imaging; Time Factors; Tomography, X-Ray Computed - trends; Vasospasm, Intracranial - diagnostic imaging; Vasospasm, Intracranial - etiology
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.06.040

Recent literature suggests there are sex differences in delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Our study serves to compare sex differences in radiographic vasospasm, DCI, and clinical outcome after aSAH, and to determine whether there are age-dependent differences. A total of 328 patients with ruptured cerebral aneurysms were evaluated for radiographic vasospasm, clinical deterioration, cerebral infarction, and modified Rankin Scale-determined clinical outcome at 6 months to 1 year after rupture. Multivariate regression analyses were performed to evaluate the associations between these outcome measures and sex, adjusting for age, hypertension, aneurysm location, admission Hunt and Hess grade, and modified Fisher grade. After multivariate adjustment, women had higher rates of radiographic vasospasm (β = 0.35; 95% confidence interval [CI], 0.068-0.63; P = 0.015), clinical deterioration (odds ratio [OR], 2.8; 95% CI, 1.3-6.0; P = 0.008) and cerebral infarction (OR, 2.4; 95% CI, 1.0-5.5; P = 0.039), but no difference was observed in follow-up modified Rankin Scale (mRS) outcome score at 6 months to 1 year (P = 0.96). Older women (age >55 years) have a higher rate of clinical deterioration than men in the same age group (OR, 3.5; 95% CI, 1.0-12; P = 0.043). In contrast, younger women (age ≤55 years) had increased radiographic vasospasm (β = 0.55; 95% CI, 0.17-0.93; P = 0.005) and worse mRS outcome score (β = 0.042; 95% CI, -0.021 to 1.1; P = 0.042) compared with men. Female sex is associated with a higher risk of radiographic vasospasm, clinical deterioration, and cerebral infarction. Furthermore, this association appears to be age-dependent. This study further supports the unique role of sex, and highlights the need to better understand the possible role of female hormones in the development of complications of subarachnoid hemorrhage.