Sex Disparities in Neonatal Arterial Ischemic Stroke: Larger Lesion Volume and More Severe Long-Term Disability in Male Infants.

BACKGROUND

To examine the relationship between sex and infarct volume in neonatal arterial ischemic stroke (NAIS) and to compare the functional outcomes of male and female infants at 2 years of age.

METHODS

A prospective observational multicenter study was conducted in 6 hospitals in Spain. Sixty-four consecutive infants with idiopathic and symptomatic NAIS were recruited. Lesion masks were created to determine NAIS volume and location. Data on acute-phase symptoms, including seizure occurrence and anticonvulsant drugs used and functional outcomes at 2 years, including need for speech therapy, were collected. Dichotomous categorical variables were compared between males and females using chi-square or logistic regression tests, while differences in continuous variables were assessed by means of t-tests. Analysis of covariance or logistic regression was performed to adjust for infarct volume.

RESULTS

Male infants presented a higher prevalence of NAIS compared to females (61% vs 39%). In addition, males showed larger infarct volumes and a differential pattern in the spatial distribution of lesions (P < 0.05). The male group also presented higher rates of postnatal epilepsy (41% vs 12%; P = 0.019), need for speech therapy (58% vs 24%; P = 0.010), and strabismus at 2 years of age (18% vs 0%).

CONCLUSIONS

Our results point to larger infarct volumes and a worse outcome in males affected by NAIS. These results, together with further studies on the differential effects associated with sex in the context of NAIS, may shape new sex-specific neuroprotective strategies and follow-up plans.