Gender and the Injured Brain

Vagnerova, Kamila; Koerner, Ines P.; Hurn, Patricia D.

doi:10.1213/ane.0b013e31817326a5

Cited by 99 publications

(71 citation statements)

References 227 publications

(142 reference statements)

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“…There are conflicting data regarding whether stroke occurs more frequently in men than in women. 48,49 The role of extracranial carotid artery stenosis on perioperative stroke remains controversial. 16,49 Carotid bruit does not correlate with the severity of the underlying carotid artery stenosis, per se, and has not been shown to increase the risk of perioperative stroke.…”

Section: Comorbiditiesmentioning

confidence: 99%

Perioperative Stroke in Noncardiac, Nonneurosurgical Surgery

2011

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Perioperative stroke after noncardiac, nonneurosurgical procedures is more common than generally acknowledged. It is reported to have an incidence of 0.05-7% of patients. Most are thrombotic in origin and are noted after discharge from the postanesthetic care unit. Common predisposing factors include age, a previous stroke, atrial fibrillation, and vascular and metabolic diseases. The mortality is more than two times greater than in strokes occurring outside the hospital. Delayed diagnosis and a synergistic interaction between the inflammatory changes normally associated with stroke, and those normally occurring after surgery, may explain this increase.Intraoperative hypotension is an infrequent direct cause of stroke. Hypotension will augment the injury produced by embolism or other causes, and this may be especially important in the postoperative period, during which monitoring is not nearly as attentive as in the operating room. Increased awareness and management of predisposing risk factors with early detection should result in improved outcomes. STROKE is an important cause of morbidity and mortality, particularly in patients more than 65 yr old. In cardiac, neurologic, and carotid surgery, the incidence is known to be high (2.2-5.2%).1 However, little is known regarding perioperative stroke following other types of surgery including general, urologic, orthopedic, thoracic, and gynecologic procedures. The aims of this article are to review the incidence, pathophysiology, risk factors, and outcomes associated with perioperative stroke following noncardiac, nonneurologic, and vascular surgery. Suggestions regarding the timing of elective surgery after stroke and ways in which one can reduce the incidence and improve outcomes are also outlined. DefinitionThe World Health Organization definition of stroke is a "focal or global neurologic deficit of cerebrovascular cause that persists beyond 24 h or is interrupted by death within 24 h." Transient ischemic attack is acute loss of focal cerebral or ocular function with symptoms lasting less than 24 h and is usually presumed to be embolic or thrombotic in origin. In addition, a third type of cerebrovascular event has recently attracted much attention in the nonsurgical setting. Covert stroke is an asymptomatic ischemic event usually only detected by advanced neuroimaging techniques, such as diffusion-weighted magnetic resonance imaging sequences.2 Although the diagnosis is often missed at the time of the event, covert stroke has been associated with an adverse effect on cognitive function and quality of life. Currently other than in cardiac and carotid artery surgery, there is no study evaluating the incidence, impact, and risk factors of covert stroke in the general surgical population.

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Section: Comorbiditiesmentioning

confidence: 99%

Perioperative Stroke in Noncardiac, Nonneurosurgical Surgery

2011

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“…Progesterone appears to have a neuroprotective action, and it may have potential as a treatment for brain edema in patients with TBI. 20,21 Clinical studies have been inconclusive. Some suggest that progesterone improves outcomes in patients with TBI, 22,23 whereas others 2,[24][25][26][27] suggest that sex is not related to the severity of TBI and that females do not have better outcomes than males.…”

Section: Raumatic Brain Injurymentioning

confidence: 99%

Protection From Traumatic Brain Injury in Hormonally Active Women vs Men of a Similar Age

Yeung¹

2011

Arch Surg

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Background: It has been suggested that women with traumatic brain injury have more favorable outcomes than do men because of higher levels of circulating estrogen and progesterone that may reduce brain edema.Objectives: To determine whether there is any association between sex and mortality in TBI patients and whether there is any association between sex and brain edema. Design: Retrospective cohort study using data from 2001 to 2007 collected from a trauma registry in Hong Kong and the Victorian State Trauma Registry.Setting: Two regional trauma centers in Hong Kong and 2 adult major trauma centers and 1 pediatric trauma center in Victoria, Australia.Main Outcome Measures: Mortality and brain edema.Patients: Trauma patients with an Abbreviated Injury Scale score (head) of at least 3 who were aged 12 to 45 years were included. Patients with minor head injury and undisplaced closed skull fracture were excluded.Results: Both the Hong Kong and Victorian data showed no significant difference in sex-related mortality. Increased mortality was associated with decreased systolic blood pressure and Glasgow Coma Scale score and with increased New Injury Severity Score or Injury Severity Score. In Hong Kong, brain edema was associated with female sex (P = .02), and the odds of brain edema in females were greater than for males. However, this association was not found in Victorian patients. Conclusion:This study found no significant association between sex and mortality in either Victoria or Hong Kong and does not support the concept that females have better outcomes after traumatic brain injury.

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“…However, women may derive greater benefit from thrombolysis compared with men, although this is controversial (Meseguer et al, 2009). These gender differences in IS have been explained by both hormone-dependent and hormone-independent mechanisms (Liu et al, 2009;Vagnerova et al, 2008). For example, gender differences in peripheral and brain immune and inflammatory responses, cell apoptosis, and cell death may contribute (Libert et al, 2010;Siegel et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Effects of Gender on Gene Expression in the Blood of Ischemic Stroke Patients

Tian

Stamova

Jickling

et al. 2011

J Cereb Blood Flow Metab

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This study examined the effects of gender on RNA expression after ischemic stroke (IS). RNA obtained from blood of IS patients (n = 51; 153 samples at p3, 5, and 24 hours) and from matched controls (n = 52) were processed on Affymetrix microarrays. Analyses of covariance for stroke versus control samples were performed separately for both genders and the regulated genes for females compared with males. In all, 242, 227, and 338 male-specific genes were regulated at p3, 5, and 24 hours after IS, respectively, of which 59 were regulated at all time points. Overall, 774, 3,437, and 571 female-specific stroke genes were regulated at p3, 5, and 24 hours, respectively, of which 152 were regulated at all time points. Male-specific stroke genes were associated with integrin, integrin-liked kinase, actin, tight junction, Wnt/b-catenin, RhoA, fibroblast growth factors (FGF), granzyme, and tumor necrosis factor receptor (TNFR)2 signaling. Female-specific stroke genes were associated with p53, high-mobility group box-1, hypoxia inducible factor (HIF)1a, interleukin (IL)1, IL6, IL12, IL18, acute-phase response, T-helper, macrophage, and estrogen signaling. Cell death signaling was overrepresented in both genders, although the molecules and pathways differed. Gender affects gene expression in the blood of IS patients, which likely implies gender differences in immune, inflammatory, and cell death responses to stroke.

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Gender and the Injured Brain

Cited by 99 publications

References 227 publications

Perioperative Stroke in Noncardiac, Nonneurosurgical Surgery

Perioperative Stroke in Noncardiac, Nonneurosurgical Surgery

Protection From Traumatic Brain Injury in Hormonally Active Women vs Men of a Similar Age

Effects of Gender on Gene Expression in the Blood of Ischemic Stroke Patients

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