gms | German Medical Science

Objective: Proper management of patients with subarachnoid hemorrhage (SAH) includes the consideration of relevant risk factors for cerebral vasospasm (CV). Among them, young age is a generally accepted vasospasm predictor. However, the impact of patients’ sex on CV is still the point at issue. Here, we analyze the value of sex on post-SAH CV with the special focus on the patients’ age.

Methods: All consecutive patients with aneurysmal SAH treated at our institution between January 2003 and December 2015 were eligible for this study. Along with demographic parameters, the following data were also collected: clinical and radiographic severity of SAH, occurrence of symptomatic CV and cerebral infarctions (on computed tomography follow-up scans). Sex-specific differences in the incidence of CV were analyzed both in the whole cohort, and in different age groups.

Results: This study included 955 patients of which 640 (67%) were female. The median age of the cohort was 55 years. Female patients were at higher risk for symptomatic CV (p= 0.0264, odds ratio (OR) = 1.49). As expected, both genders showed a decrease in CV incidence with increasing age. However, male patients showed an earlier decline of CV incidence after reaching the median age of the cohort. By contrast, CV persisted in the sub-group of females aged between 55 and 70, showing the strongest difference to the male counterpart (p<0.0001). In addition, the occurrence of cerebral infarction in these age groups showed also a sex-dependent inverse pattern: females between 55 and 70 years old had the highest infarct rates (50.3% versus 43.3% for younger/older females). Inversely, 55-70-aged males had lower rates of infarction, than other male SAH patients (41.3% and 48.7% respectively). In the multivariate analysis, female sex predicted symptomatic CV independently from age and clinical/radiographic severity of SAH (p=0.006, OR=1.68).

Conclusion: Our data confirm the role of female sex for CV after SAH. Especially post-menopausal females are at particular risk for CV and the ischemic complications. Possibly, the reason is hormonal (decline of estrogen levels and increase of plasma-renin activity) or later onset of atherosclerosis, or both.