Introduction: The impact of sex differences on the pathophysiology and its effect on clinical outcomes of patients with subarachnoid hemorrhage (SAH) remains unclear. A retrospective cohort of SAH patients treated at a single-institution was retrospectively reviewed to determine the impact of sex differences on outcome after SAH.

Methods: The authors identified 675 patients with SAH (May 2008—December 2013) and analyzed the impact of sex differences on predisposing factors, Hunt&Hess (H&H) grade, Fisher grade, complications and outcome by modified Rankin Scale (mRS) at discharge, 6 weeks, 3, 6, 9, 12, 18, 24, and 36 months, as well as discharge disposition and time to recovery.

Results: Age and H&H grade adjusted female-to-male odds ratio for favorable outcome was 3.86 (95% CI:1.07-14.85) at 6 months (p=0.04). Favorable outcome was significantly more common in the 45-54 age group in females at 6 months (100.0% vs 72.7%;p=0.01). Males in the 55-64 age group were significantly more likely to have favorable outcome compared to females of the same age group at 3 months (100.0% vs 73.3%;p=0.02). The median time to recovery was 1.5 months for females and 6 months for males in the 45-54 age group (p=0.02). No significant sex differences were obtained in H&H grade (p=0.19) and Fisher grade (p=0.84). Discharge disposition was similar between sexes (p=0.74).

Conclusions: Female sex is associated with significantly higher odds of favorable outcome at 6 months. Favorable outcome was significantly higher and time to functional recovery was significantly shorter in females aged 45-54 years than males suggesting a potential benefit of sex hormones in pre-menopausal women.

Patient Care: Our findings suggest that sex steroids may confer a protective effect in premenopausal women, and lack of endogenous sex steroids is associated with detrimental outcomes. With earlier age (14-44) and advanced age (85-94 year old), sex related differences in functional outcome are not pronounced as in the perimenopasual group. These findings also support the hypothesis that treatment with sex steroids may be beneficial in the setting of acute brain injury induced by SAH but these observations require further definitive testing in prospectively evaluated subjects.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the gender differences in functional outcome after SAH 2) Discuss the effect of menopause in functional outcome after SAH 3) Identify the potential role of sex steroids in the treatment of subarachnoid hemorrhage

References: Turan N, Heider RA, Zaharieva D, Ahmad FU, Barrow DL, Pradilla G. Sex Differences in the Formation of Intracranial Aneurysms and Incidence and Outcome of Subarachnoid Hemorrhage: Review of Experimental and Human Studies. Transl Stroke Res. Feb 2016;7(1):12-19.