Sex Differences in Markers of Cerebral Small Vessel Disease in Patients with Lobar Intracerebral Hemorrhage.

Introduction: Cerebral small vessel disease (CSVD) is a major cause of primary lobar intracerebral hemorrhage (ICH) due to cerebral amyloid angiopathy (CAA) or hypertensive arteriopathy (HA). Sex differences in CSVD imaging markers and prevalence of CAA vs HA in lobar ICH remain unexplored.

Methods: We performed a retrospective analysis of patients with primary lobar ICH who underwent MRI during hospitalization. We collected demographic, clinical, and outcome data. We reviewed MRIs for CSVD markers and calculated composite CSVD burden score (cCSVDbs). We assigned possible/probable CAA using Boston criteria 2.0. We grouped patients based on their sex and examined associations between sex and CSVD markers, cCSVDbs, or CAA. Kaplan Meier survival analysis was used to determine ICH-onset age among patients with first-ever symptomatic lobar ICH.

Results: 214 patients were included (102 [47.66%] women). Men were more likely to be current alcohol abusers (25.69% vs. 9.09%, p = 0.002), current smokers (24.30% vs. 12.12%, p = 0.024) and have coronary artery disease (26.79% vs. 15.69%, p = 0.048), and hyperglycemia on admission (142.79 ± 59.59 vs. 126.58 ± 37.29, p = 0.019). Women were older (74.91 ± 11.69 vs. 69.28 ± 14.53 years, p = 0.002), and more likely to have possible/probable CAA in univariate (97.06% vs. 88.39%; OR: 4.33, 95% CI: 1.19-15.67; p = 0.025) but not multivariate analysis. We found no significant differences in MRI markers of CSVD, cCSVDbs, or CAA. Among patients who presented with their first-ever primary symptomatic lobar ICH (n = 187), men were younger than women (73 vs 77 years, p = 0.001).

Conclusions: In our cohort of patients with primary lobar ICH, we found no significant difference in clinical and imaging characteristics between sexes. However, men were more likely to have a younger lobar ICH-onset age compared to women.