ArticleNature communications2021
Outcome after acute ischemic stroke is linked to sex-specific lesion patterns.
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In one paragraph
Article in Nature communications, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 2 of them syntheses that pooled it.
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60citing papers in PubMed, 2 pooled it
10.1field-weighted citation impact, top 1% of its field
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
60 citing papers in PubMed, 2 syntheses or guidelines pooled it, 100 citations in OpenAlex.
- Mendelian randomization studies of lifestyle-related risk factors for stroke: a systematic review and meta-analysis.Frontiers in endocrinology · 2024Pooled it
- Demographic reporting across a decade of neuroimaging: a systematic review.Brain imaging and behavior · 2022Pooled it
- The relevance of rich club regions for functional outcome post-stroke is enhanced in women.Human brain mapping · 2023Trial
- Sex differences in imaging and clinical characteristics of patients from the WAKE-UP trial.European journal of neurology · 2023Trial
- Sex-Specific Association Between Socioeconomic Status and Stroke Mortality.Journal of the American Heart Association · 2026Article
- Photothrombotic and middle cerebral artery occlusion models produce distinct neurovascular injury and sex-dependent outcomes.Scientific reports · 2026Article
- Robust but independent sex differences in human brain function, structure, and behavior.Nature communications · 2026Article
- Geographic disparities in EVT access and stroke mortality under universal health coverage in South Korea.BMC health services research · 2026Article
- A2-pancortins interact with Bcl-xL and WAVE1 to promote mitochondria-ER contact sites (MERCs) and exacerbate mitochondrial calcium elevation to mediate cell death in stroke.Scientific reports · 2026Article
- Deep generative computed perfusion-deficit mapping of ischaemic stroke.Communications biology · 2026Article
- Sex Differences in Prognostic Markers: Exploring Outcome Variability After Mechanical Thrombectomy in Large Vessel Occlusion Stroke.Journal of clinical medicine · 2025Article
- Impact of Corticospinal Tract Involvement Beyond ASPECTS on Brain Imaging Prior to Endovascular Therapy in Patients with Large Ischemic Core.Stroke (Hoboken, N.J.) · 2025Article
- Temporal trend and attributable risk factors of ischemic stroke burden in China, 1990-2021.BMC neurology · 2025Article
- ABO exon polymorphisms are related to ischemic stroke in a Chinese Han population.BMC medical genomics · 2025Article
- Body Representation in Stroke Patients: A Systematic Review of Human Figure Graphic Representation.Journal of clinical medicine · 2025Review
- Fatty Acid Ratios Versus Conventional Risk Factors in Stroke: Insights into Severe Disability and Mortality Outcomes.Nutrients · 2025Article
- Sex differences in age-associated neurological diseases-A roadmap for reliable and high-yield research.Science advances · 2025Review
- Evaluating the Rehabilitation Needs of Stroke Patients in China: A Trend Analysis From 1990 to 2019.Brain and behavior · 2025Article
- Sensitivity of diffusion tensor imaging to regional mixed cerebrovascular pathology.Brain communications · 2025Article
- Sex-specific infarct volume associations and early prediction of language impairment progression following stroke surgery: a network approach.Frontiers in neurology · 2025Article
Corrections and comments
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Authors and funding
58 authors at 20 institutions in 13 countries.
Anna K BonkhoffJ. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. abonkhoff@mgh.harvard.edu.ORCID 0000-0002-5927-1089
Markus D SchirmerJ. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Martin BretznerJ. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.ORCID 0000-0002-7594-4159
Sungmin HongJ. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Robert W RegenhardtJ. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.ORCID 0000-0003-2958-3484
Mikael BrudforsSchool of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
Kathleen L DonahueJ. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Marco J NardinJ. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Adrian V DalcaComputer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Boston, MA, USA.
Anne-Katrin GieseDepartment of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Mark R EthertonJ. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Brandon L HancockAthinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
Steven J T MockingAthinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
Elissa C McIntoshAthinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
John AttiaHunter Medical Research Institute, Newcastle, NSW, Australia.ORCID 0000-0001-9800-1308
Oscar R BenaventeDepartment of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada.
Stephen BevanSchool of Life Sciences, University of Lincoln, Lincoln, UK.
John W ColeDepartment of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA.
Amanda DonattiSchool of Medical Sciences, University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Sao Paulo, Brazil.
Christoph J GriessenauerDepartment of Neurosurgery, Geisinger, Danville, PA, USA.
Laura HeitschDepartment of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA.
Lukas HolmegaardDepartment of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Katarina JoodDepartment of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Jordi Jimenez-CondeDepartment of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain.
Steven J KittnerDepartment of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA.
Robin LemmensKU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), Leuven, Belgium.
Christopher R LeviSchool of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
Caitrin W McDonoughDepartment of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL, USA.
James F MeschiaDepartment of Neurology, Mayo Clinic, Jacksonville, FL, USA.ORCID 0000-0002-4475-8142
Chia-Ling PhuahDepartment of Neurology, Washington University School of Medicine & Barnes-Jewish Hospital, St Louis, MO, USA.
Arndt RolfsCentogene AG, Rostock, Germany.
Stefan RopeleDepartment of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria.ORCID 0000-0002-5559-768X
Jonathan RosandJ. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Jaume RoquerDepartment of Neurology, Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain.
Tatjana RundekDepartment of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
Ralph L SaccoDepartment of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
Reinhold SchmidtDepartment of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria.
Pankaj SharmaInstitute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK.
Agnieszka SlowikDepartment of Neurology, Jagiellonian University Medical College, Krakow, Poland.
Martin SöderholmDepartment of clinical sciences Malmö, Lund University, Lund, Sweden.
Alessandro SousaSchool of Medical Sciences, University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Sao Paulo, Brazil.
Tara M StanneDepartment of Laboratory Medicine, Institute of Biomedicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Daniel StrbianDepartment of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.ORCID 0000-0001-9095-2344
Turgut TatlisumakDepartment of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Vincent ThijsStroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
Achala VagalDepartment of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Johan WasseliusDepartment of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden.
Daniel WooDepartment of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Ramin ZandDepartment of Neurology, Geisinger, Danville, PA, USA.
Patrick F McArdleDivision of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Bradford B WorrallDepartments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, USA.ORCID 0000-0001-9386-4091
Christina JernDepartment of Laboratory Medicine, Institute of Biomedicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Arne G LindgrenDepartment of Neurology, Skåne University Hospital, Lund, Sweden.
Jane MaguireUniversity of Technology Sydney, Sydney, NSW, Australia.
Danilo BzdokDepartment of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, Faculty of Medicine, School of Computer Science, McGill University, Montreal, QC, Canada.ORCID 0000-0003-3466-6620
Ona WuAthinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
MRI-GENIE and GISCOME Investigators and the International Stroke Genetics Consortium
Natalia S RostJ. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Harvard University · USMassachusetts General Hospital · USSahlgrenska University Hospital · SELund University · SEUniversity of Maryland, Baltimore · USBarnes-Jewish Hospital · USGeisinger Medical Center · USMedical University of Graz · ATUniversidade Estadual de Campinas (UNICAMP) · BRUniversitat Autònoma de Barcelona · ESUniversity of Cincinnati Medical Center · USUniversity of Miami · USCentogene (Germany) · DEFlorey Institute of Neuroscience and Mental Health · AUHunter Medical Research Institute · AUJagiellonian University · PLJohn Hunter Hospital · AUKing's College London · GBMontreal Neurological Institute and Hospital · CARoyal Holloway University of London · GB
Funding
DISCOVERY - Statistics and Analysis CoreU19NS115388 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI Steven M Greenberg, Natalia S Rost · 2019 to 2026
$75.4MMaking Acute Stroke Trials Succeed: Challenges and Potential SolutionsU01NS110772 · NINDS · UNIVERSITY OF CINCINNATI · PI Joseph Paul Broderick, Jordan J. Elm · 2020 to 2026
$24.3MMulti-arm Optimization of Stroke Thrombolysis (MOST) Stroke TrialU01NS100699 · NINDS · WASHINGTON UNIVERSITY · PI ADEOYE, OPEOLU M, BARRETO, ANDREW D · 2018 to 2021
$18.8MICH Recovery GrantR01NS100417 · NINDS · UNIVERSITY OF CINCINNATI · PI WOO, DANIEL · 2017 to 2021
$5.3MMRI-GENetics Interface Exploration_MRI-GENIE_StudyR01NS086905 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI ROST, NATALIA S · 2015 to 2019
$3.3MAssessing Population-based Radiological brain health in Stroke Epidemiology (APRISE) StudyR01NS103824 · NINDS · UNIVERSITY OF CINCINNATI · PI KHATRI, POOJA, KISSELA, BRETT M · 2018 to 2022
$3.1MStatins augment small vessel function and improve stroke outcomesR01NS082285 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI ROST, NATALIA S · 2013 to 2017
$2.6MCNV And Stroke (CaNVAS)R01NS114045 · NINDS · UNIVERSITY OF MARYLAND BALTIMORE · PI COLE, JOHN W. · 2020 to 2024
$2.6MInvestigating the impact of loneliness on brain aging and pre-symptomatic Alzheimer's disease progressionR01AG068563 · NIA · MCGILL UNIVERSITY · PI BZDOK, DANILO, SPRENG, ROBERT NATHAN · 2020 to 2024
$2.3MAPRISE Dementia (Assessing Population-based Radiological brain health in Stroke Epidemiology-Dementia)RF1NS117643 · NINDS · UNIVERSITY OF CINCINNATI · PI KHATRI, POOJA, KISSELA, BRETT M · 2020 to 2020
$2.0MBLRD VA I01 BX004672NIA NIH HHS R01 AG068563NINDS NIH HHS R01 NS082285NINDS NIH HHS R01 NS086905NINDS NIH HHS R01 NS100417NINDS NIH HHS R01 NS103824NINDS NIH HHS R01 NS114045NINDS NIH HHS RF1 NS117643NINDS NIH HHS U01 NS100699NINDS NIH HHS U01 NS110772NINDS NIH HHS U19 NS115388
Abstract
Acute ischemic stroke affects men and women differently. In particular, women are often reported to experience higher acute stroke severity than men. We derived a low-dimensional representation of anatomical stroke lesions and designed a Bayesian hierarchical modeling framework tailored to estimate possible sex differences in lesion patterns linked to acute stroke severity (National Institute of Health Stroke Scale). This framework was developed in 555 patients (38% female). Findings were validated in an independent cohort (n = 503, 41% female). Here, we show brain lesions in regions subserving motor and language functions help explain stroke severity in both men and women, however more widespread lesion patterns are relevant in female patients. Higher stroke severity in women, but not men, is associated with left hemisphere lesions in the vicinity of the posterior circulation. Our results suggest there are sex-specific functional cerebral asymmetries that may be important for future investigations of sex-stratified approaches to management of acute ischemic stroke.
Indexed as
AgedAged, 80 and overBayes TheoremBrain MappingBrain StemCerebral RevascularizationCohort StudiesFemaleHumansImage Processing, Computer-AssistedIschemic StrokeMagnetic Resonance ImagingMaleMiddle AgedRisk FactorsSensorimotor Cortex
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