Subarachnoid hemorrhage and the female sex: analysis of risk factors, aneurysm characteristics, and outcomes

Clinical article

Alhafidz Hamdan M.B.B.S.1, Jonathan Barnes M.B.B.S.1, and Patrick Mitchell F.R.C.S.2
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  • 1 Faculty of Medical Sciences, Newcastle University;
  • | 2 Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
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Object

The pathophysiology of aneurysmal subarachnoid hemorrhage (aSAH) is unclear. Sex may play a role in the outcome of patients with aSAH.

Methods

The authors retrospectively identified 617 patients with aSAH (April 2005 to February 2010) and analyzed sex differences in risk factors (age, hypertension, smoking, alcohol consumption, and family history), admission-related factors (World Federation of Neurosurgical Societies grade and admission delay), aneurysm characteristics (site, side, location, and multiplicity), and outcomes (treatment modalities [coiling/clipping/both/conservative], complications [vasospasm and hydrocephalus], length of stay, and modified Rankin Scale score at 3 months).

Results

The female patients with aSAH were older than the male patients (mean age 56.6 vs 51.9 years, respectively, p < 0.001), and more women than men were ≥ 55 years old (56.2% vs 40.4%, respectively, p < 0.001). Women exhibited higher rates of bilateral (6.8% vs 2.6%, respectively, p < 0.05), multiple (11.5% vs 5.2%, respectively, p < 0.05), and internal carotid artery (ICA) (36.9% vs 17.5%, respectively, p < 0.001) aneurysms and a lower rate of anterior cerebral artery aneurysms (26.3% vs 44.8%, respectively, p < 0.001) than the men, but no side differences were noted. There were no sex differences in risk factors, admission-related factors, or outcome measures. For both sexes, outcomes varied according to aneurysm location, with odds ratios for a poor outcome of 1.62 (95% CI 0.91–2.86, p = 0.1) for middle cerebral artery, 2.41 (95% CI 1.29–4.51, p = 0.01) for ICA, and 2.41 (95% CI 1.29–4.51, p = 0.006) for posterior circulation aneurysms compared with those for anterior cerebral artery aneurysms. The odds ratio for poor outcome (modified Rankin Scale score of 4–6) in women compared with men after adjusting for significant prognostic factors was 0.71 (95% CI 0.45–1.11, p > 0.05).

Conclusions

The overall outcomes after aSAH between women and men are similar.

Abbreviations used in this paper:

ACA = anterior cerebral artery; aSAH = aneurysmal subarachnoid hemorrhage; ICA = internal carotid artery; MCA = middle cerebral artery; mRS = modified Rankin Scale; PC = posterior circulation; WFNS = World Federation of Neurosurgical Societies.

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