ArticlemedRxiv : the preprint server for health sciences2025
Sex Differences in the Protective Effect of Brain Volume: Age Attenuates Protection in Females.
Article in medRxiv : the preprint server for health sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Sex differences in outcomes after acute ischemic stroke (AIS) are well recognized, but mechanisms remain unclear. This study evaluates whether parenchymal brain volume (PBV), age, and final infarct volume (DWI-FIV) explain sex-specific differences in post-stroke disability. Methods: We analyzed a prospectively collected multicenter registry of AIS patients treated between 2015 and 2024. Automated pipelines quantified PBV from non-contrast CT and DWI-FIV from 24-48-hour MRI. With the primary outcome being 90-day functional independence (mRS 0-2), sex-stratified logistic regression models evaluated its association with PBV. Logistic and linear models examined sex-specific relationships among covariables. Results: Among 1,103 patients, 48% were female, median age was 66 [IQR 56-77], median NIHSS was 9 [IQR 4-17], and median DWI-FIV was 7.8 [IQR 0.2-36.3]. Functional independence at 90 days was achieved in 51.7% of males versus 44.9% of females ( Conclusion: PBV was protective in males but less so in females, where stronger age-related effects on infarct size and severity abrogated its benefit. These suggest aging weakens brain reserve in women, emphasizing the importance of sex and brain volume measurements in outcome models.
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