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Cited by 113Traumatic Brain Injury and Neurovascular DisturbancesTraumatic Brain Injury ResearchTrauma and Emergency Care Studies

Sex-related differences in patients with severe head injury: greater susceptibility to brain swelling in female patients 50 years of age and younger

Farin, Azadeh, Deutsch, Reena, Biegon, Anat, Marshall, Lawrence F.·2003·Journal of Neurosurgery
DOI 10.3171/jns.2003.98.1.0032
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Abstract

Object. The goal of this study was to study the influence of sex and age on factors affecting patient outcome in severe head injury. Methods. Data from the prospectively conducted international trial of tirilazad mesylate in patients with head injury were analyzed retrospectively. Included were 957 patients, 23% of whom were female and all of whom were between the ages of 15 and 79 years. All patients presented with Glasgow Coma Scale (GCS) scores between 3 and 8 and evidence of structural brain damage and/or subarachnoid hemorrhage (SAH) on the initial CT scan. Frequencies of recognized risk factors, including brain swelling, intracranial hypertension, systemic hypotension, advanced age, SAH, and injury severity (based on GCS scores), as well as dichotomized Glasgow Outcome Scale (GOS) scores (good recovery or moderate disability compared with severe disability, persistent vegetative state, or death) obtained 6 months postinjury were compared between male and female patients. Conclusions. Overall significantly greater frequencies of brain swelling and intracranial hypertension were found in female compared with male patients (35% compared with 24% [p < 0.0008] and 39 compared with 31% [p < 0.03], respectively). The highest rates were found in female patients younger than 51 years old (38% compared with 24% [p < 0.002] and 40% compared with 30% [p < 0.02], respectively, in male patients younger than 51 years of age). This effect was independent of injury severity (GCS) scores, which were not different in male and female patients. Female patients younger than 50 years tended to have worse outcomes, but the difference was not statistically significant. Thus, female patients who sustain severe head injury, especially (presumably) premenopausal ones aged 50 years and younger, are significantly more likely to experience brain swelling and intracranial hypertension than male patients with a comparable injury severity, suggesting that younger women may benefit from more aggressive monitoring and treatment of intracranial hypertension.

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  • Sex-related differences in fMRI activity, heart rate variability, edema, and intracranial hypertension were reported even in the absence of differences in cognition, post-concussive symptoms, duration of recovery, and GOS.

    “Indeed, sex-related differences in functional magnetic resonance imaging (fMRI) activity, heart rate variability, edema, and intracranial hypertension were reported even in the absence of differences in cognition, post-concussive symptoms, duration of recovery, and GOS. 13,55,56”

    From Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know (2019) · cites this paper as [13]

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Authors
Farin, A., Deutsch, R., Biegon, A., & Marshall, L. F.
Affiliations
  • University of California San Diego (US)
  • Lawrence Berkeley National Laboratory (US)
ORCID
Biegon, Anat
Venue
Journal of Neurosurgery
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Published
2003-01
Volume
98
Issue
1
Pages
32-36
ISSN
0022-3085 (ISSN-L)
DOI
10.3171/jns.2003.98.1.0032
OpenAlex
W2028606587
Cited by
113
References
35
Citations by year
2026: 3 · 2025: 2 · 2024: 3 · 2023: 5 · 2022: 7 · 2021: 10 · 2020: 1 · 2019: 5 · 2018: 4 · 2017: 4 · 2016: 2 · 2015: 3 · 2014: 3 · 2013: 4 · 2012: 3
FWCI
4.52
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of neurosurgery (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Center for Research Resources (M-01RR00827, M01RR000827)
Topics
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
Keywords
sex differences, severe traumatic brain injury, traumatic brain injury, cerebral edema, intracranial hypertension, tirilazad mesylate, age, premenopausal women, Glasgow Outcome Scale, injury severity, subarachnoid hemorrhage, systemic hypotension
MeSH terms
Adolescent, Adult, Age Factors, Aged, Brain Edema, Brain Injuries, Female, Humans, Male, Middle Aged, Retrospective Studies, Sex Factors, Tomography, X-Ray Computed, Trauma Severity Indices, Outcome Assessment, Health Care, Intracranial Hypertension, Glasgow Outcome Scale

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