{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:48:02Z","timestamp":1782820082607,"version":"3.54.5"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Causes of intracerebral haemorrhage (ICH), in particular cerebral small vessel disease (SVD), are a frequent subject of current research, yet the potential role of sex differences remains uncertain. Therefore, we aimed to investigate whether there are sex-related differences in aetiology, MRI features of SVD and risks of recurrent cerebrovascular events in patients with ICH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>We included patients from 2 large observational ICH study cohorts (London\/UK, Graz\/Austria) with available MRI. ICH aetiology was defined based on brain MRI, vascular imaging as well as clinical findings. Multivariable regression models were fitted to assess sex differences in aetiology, SVD MRI features and recurrent stroke events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 1043 patients (mean age 66\u00a0years, 58% male) with acute ICH. Males had a higher prevalence of cryptogenic ICH than females (aOR 1.53; 95% CI, 1.01\u20132.33). Males also had a higher rate of presence of any lacune (aOR 1.47; 95% CI, 1.11\u20131.94), severely enlarged perivascular spaces in the basal ganglia (aOR 1.45; 95% CI, 1.04\u20132.02) and presence of small asymptomatic diffusion-weighted imaging lesions (aOR 1.51; 95% CI, 1.06\u20132.15). There were no sex differences regarding recurrent ICH, incident ischaemic stroke or mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Conclusion<\/jats:title>\n                    <jats:p>The higher rate of presence of any lacune and enlarged perivascular spaces in men with ICH implies a higher severity of arteriolosclerosis. The mechanisms underlying the higher occurrence of cryptogenic ICH in men might include transient risk factors or incipient SVD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/esj\/aakag069","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T12:18:22Z","timestamp":1781871502000},"source":"Crossref","is-referenced-by-count":0,"title":["Sex differences in aetiology of intracerebral haemorrhage and associated small vessel disease patterns"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2720-6083","authenticated-orcid":false,"given":"Linda","family":"Fabisch","sequence":"first","affiliation":[{"name":"Department of Neurology, Medical University of Graz , Auenbruggerplatz 22, 8036 Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatice","family":"Ozkan","sequence":"additional","affiliation":[{"name":"UCL Stroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology , Queen Square, London WC1N 3BG ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2428-1575","authenticated-orcid":false,"given":"Philip S","family":"Nash","sequence":"additional","affiliation":[{"name":"UCL Stroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology , Queen Square, London WC1N 3BG ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenpeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"UCL Stroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology , Queen Square, London WC1N 3BG ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Locatelli","sequence":"additional","affiliation":[{"name":"UCL Stroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology , Queen Square, London WC1N 3BG ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Du","sequence":"additional","affiliation":[{"name":"UCL Stroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology , Queen Square, London WC1N 3BG ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larysa","family":"Panteleienko","sequence":"additional","affiliation":[{"name":"UCL Stroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology , Queen Square, London WC1N 3BG ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carola","family":"Tamm","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz , Auenbruggerplatz 22, 8036 Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Obergottsberger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz , Auenbruggerplatz 22, 8036 Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Haidegger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz , Auenbruggerplatz 22, 8036 Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Kneihsl","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz , Auenbruggerplatz 22, 8036 Graz ,","place":["Austria"]},{"name":"Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz , Auenbruggerplatz 9, 8036 Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerit","family":"W\u00fcnsch","sequence":"additional","affiliation":[{"name":"Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz , Auenbruggerplatz 2, 8036 Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Enzinger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz , Auenbruggerplatz 22, 8036 Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J","family":"Simister","sequence":"additional","affiliation":[{"name":"UCL Stroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology , Queen Square, London WC1N 3BG ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans R","family":"J\u00e4ger","sequence":"additional","affiliation":[{"name":"Neuroradiological Academic Unit, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology , Queen Square, London WC1N 3BG ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Gattringer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz , Auenbruggerplatz 22, 8036 Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Werring","sequence":"additional","affiliation":[{"name":"UCL Stroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology , Queen Square, London WC1N 3BG ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9043-0378","authenticated-orcid":false,"given":"Simon","family":"Fandler-H\u00f6fler","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Graz , Auenbruggerplatz 22, 8036 Graz ,","place":["Austria"]},{"name":"UCL Stroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology , Queen Square, London WC1N 3BG ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"2026063005564198700_ref1","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132021: a systematic analysis for the global burden of disease study 2021","volume":"23","author":"Feigin","year":"2024","journal-title":"Lancet Neurol"},{"key":"2026063005564198700_ref2","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1038\/s41582-024-01035-w","article-title":"Intracerebral haemorrhage\u2014mechanisms, diagnosis and prospects for treatment and prevention","volume":"20","author":"Seiffge","year":"2024","journal-title":"Nat Rev Neurol"},{"key":"2026063005564198700_ref3","doi-asserted-by":"publisher","first-page":"969185","DOI":"10.3389\/fneur.2022.969185","article-title":"Biomarkers involved in the pathogenesis of cerebral small-vessel disease","volume":"13","author":"Liu","year":"2022","journal-title":"Front Neurol"},{"key":"2026063005564198700_ref4","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1016\/s1474-4422(22)00208-3","article-title":"The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI\u2013neuropathology diagnostic accuracy study","volume":"21","author":"Charidimou","year":"2022","journal-title":"Lancet Neurol"},{"key":"2026063005564198700_ref5","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1177\/0963689718795148","article-title":"Cerebral small vessel disease","volume":"27","author":"Li","year":"2018","journal-title":"Cell Transplant"},{"key":"2026063005564198700_ref6","doi-asserted-by":"publisher","first-page":"e042550","DOI":"10.1136\/bmjopen-2020-042550","article-title":"Investigation of hypertensive arteriopathy-related and cerebral amyloid angiopathy-related small vessel disease scores in patients from a memory clinic: a prospective single-centre study","volume":"11","author":"Matsuda","year":"2021","journal-title":"BMJ Open"},{"key":"2026063005564198700_ref7","doi-asserted-by":"publisher","first-page":"3602","DOI":"10.1161\/strokeaha.120.031471","article-title":"Prevalence, characteristics, and outcomes of undetermined intracerebral hemorrhage: a systematic review and meta-analysis","volume":"52","author":"Malhotra","year":"2021","journal-title":"Stroke"},{"key":"2026063005564198700_ref8","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1212\/wnl.0000000000002792","article-title":"Sex-related differences in primary intracerebral hemorrhage","volume":"87","author":"Roquer","year":"2016","journal-title":"Neurology"},{"key":"2026063005564198700_ref9","doi-asserted-by":"publisher","first-page":"107755","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107755","article-title":"The impact of sex on epidemiology, management, and outcome of spontaneous intracerebral hemorrhage (sICH)","volume":"33","author":"Sterenstein","year":"2024","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2026063005564198700_ref10","doi-asserted-by":"publisher","first-page":"3229","DOI":"10.1161\/strokeaha.113.002814","article-title":"Sex differences in the use of early do-not-resuscitate orders after intracerebral hemorrhage","volume":"44","author":"Nakagawa","year":"2013","journal-title":"Stroke"},{"key":"2026063005564198700_ref11","doi-asserted-by":"publisher","first-page":"1055360","DOI":"10.3389\/fneur.2022.1055360","article-title":"Corrigendum: sex-differences in oral anticoagulant-related intracerebral hemorrhage","volume":"13","author":"Grundtvig","year":"2022","journal-title":"Front Neurol"},{"key":"2026063005564198700_ref12","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1136\/jnnp.2006.106500","article-title":"The risk of recurrent stroke after intracerebral haemorrhage","volume":"78","author":"Hanger","year":"2007","journal-title":"J Neurol Neurosurg Amp Psychiatry"},{"key":"2026063005564198700_ref13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000535612","article-title":"Sex-based differences in the outcomes of intracerebral haemorrhage: a systematic review and meta-analysis","volume":"53","author":"Yang","year":"2023","journal-title":"Cerebrovasc Dis"},{"key":"2026063005564198700_ref14","doi-asserted-by":"publisher","first-page":"e209540","DOI":"10.1212\/WNL.0000000000209540","article-title":"Associations of cerebral small vessel disease and chronic kidney disease in patients with acute intracerebral hemorrhage: a cross-sectional study","volume":"103","author":"Nash","year":"2024","journal-title":"Neurology"},{"key":"2026063005564198700_ref15","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.jns.2016.11.021","article-title":"The Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS): development and assessment of reliability","volume":"372","author":"Charidimou","year":"2017","journal-title":"J Neurol Sci"},{"key":"2026063005564198700_ref16","doi-asserted-by":"publisher","first-page":"e209950","DOI":"10.1212\/WNL.0000000000209950","article-title":"MRI-based prediction of macrovascular causes of intracerebral hemorrhage: the MACRO score","volume":"103","author":"Fandler-H\u00f6fler","year":"2024","journal-title":"Neurology"},{"key":"2026063005564198700_ref17","doi-asserted-by":"publisher","first-page":"e794","DOI":"10.1212\/WNL.0000000000207510","article-title":"Association of the presence and pattern of MRI markers of cerebral small vessel disease with recurrent intracerebral hemorrhage","volume":"101","author":"Fandler-H\u00f6fler","year":"2023","journal-title":"Neurology"},{"key":"2026063005564198700_ref18","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1016\/s1474-4422(13)70124-8","article-title":"Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration","volume":"12","author":"Wardlaw","year":"2013","journal-title":"Lancet Neurol"},{"key":"2026063005564198700_ref19","doi-asserted-by":"publisher","first-page":"1759","DOI":"10.1212\/wnl.0b013e3181c34a7d","article-title":"The Microbleed Anatomical Rating Scale (MARS): reliability of a tool to map brain microbleeds","volume":"73","author":"Gregoire","year":"2009","journal-title":"Neurology"},{"key":"2026063005564198700_ref20","doi-asserted-by":"publisher","first-page":"351","DOI":"10.2214\/ajr.149.2.351","article-title":"MR signal abnormalities at 1.5 T in Alzheimer\u2019s dementia and normal aging","volume":"149","author":"Fazekas","year":"1987","journal-title":"Am J Roentgenol"},{"key":"2026063005564198700_ref21","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1212\/01.wnl.0000438225.02729.04","article-title":"White matter perivascular spaces: an MRI marker in pathology-proven cerebral amyloid angiopathy?","volume":"82","author":"Charidimou","year":"2014","journal-title":"Neurology"},{"key":"2026063005564198700_ref22","doi-asserted-by":"publisher","first-page":"1496","DOI":"10.1111\/jch.13387","article-title":"Sex differences in adherence to antihypertensive treatment in patients aged above 55: the French League Against Hypertension Survey (FLAHS)","volume":"20","author":"Lefort","year":"2018","journal-title":"J Clin Hypertens"},{"key":"2026063005564198700_ref23","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1111\/ajad.13501","article-title":"Gender differences in the prevalence of stimulant misuse in the United States: 2015\u20132019","volume":"33","author":"McHugh","year":"2024","journal-title":"Am J Addict"},{"key":"2026063005564198700_ref24","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.jpsychires.2024.05.017","article-title":"Gender differences in illicit drug access, use and use disorder: analysis of national survey on drug use and health data","volume":"175","author":"Ellis","year":"2024","journal-title":"J Psychiatr Res"},{"key":"2026063005564198700_ref25","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.cpr.2017.10.012","article-title":"Sex and gender differences in substance use disorders","volume":"66","author":"McHugh","year":"2018","journal-title":"Clin Psychol Rev"},{"key":"2026063005564198700_ref26","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1097\/adm.0b013e3181a0f5dc","article-title":"Temporal and gender trends in concordance of urine drug screens and self-reported use in cocaine treatment studies","volume":"3","author":"Schuler","year":"2009","journal-title":"J Addict Med"},{"key":"2026063005564198700_ref27","doi-asserted-by":"publisher","first-page":"1692","DOI":"10.1161\/STROKEAHA.121.036233","article-title":"Trigger factors for spontaneous intracerebral hemorrhage: a case-crossover study","volume":"53","author":"Van Etten","year":"2022","journal-title":"Stroke"},{"key":"2026063005564198700_ref28","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1007\/s11154-010-9134-4","article-title":"Endothelial dysfunction in diabetes mellitus: molecular mechanisms and clinical implications","volume":"11","author":"Tabit","year":"2010","journal-title":"Rev Endocr Metab Disord"},{"key":"2026063005564198700_ref29","doi-asserted-by":"publisher","first-page":"e2439571","DOI":"10.1001\/jamanetworkopen.2024.39571","article-title":"Sex differences in frequency, severity, and distribution of cerebral microbleeds","volume":"7","author":"Fandler-H\u00f6fler","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026063005564198700_ref30","doi-asserted-by":"publisher","first-page":"e107","DOI":"10.1212\/WNL.0000000000201349","article-title":"Determinants of perivascular spaces in the general population: a pooled cohort analysis of individual participant data","volume":"100","author":"Evans","year":"2023","journal-title":"Neurology"},{"key":"2026063005564198700_ref31","doi-asserted-by":"publisher","first-page":"792","DOI":"10.3174\/ajnr.a7900","article-title":"Sex-specific patterns of cerebral atrophy and enlarged perivascular spaces in patients with cerebral amyloid angiopathy and dementia","volume":"44","author":"Pinho","year":"2023","journal-title":"Am J Neuroradiol"},{"key":"2026063005564198700_ref32","doi-asserted-by":"publisher","first-page":"1699","DOI":"10.1212\/01.wnl.0000143058.40388.44","article-title":"Different progression rates for deep white matter hyperintensities in elderly men and women","volume":"63","author":"Van Den Heuvel","year":"2004","journal-title":"Neurology"},{"key":"2026063005564198700_ref33","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1136\/jnnp.70.1.9","article-title":"Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam scan study","volume":"70","author":"De Leeuw","year":"2001","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2026063005564198700_ref34","doi-asserted-by":"publisher","first-page":"e003477","DOI":"10.1161\/JAHA.116.003477","article-title":"Cerebral microbleeds, vascular risk factors, and magnetic resonance imaging markers: the northern Manhattan study","volume":"5","author":"Caunca","year":"2016","journal-title":"J Am Heart Assoc"},{"key":"2026063005564198700_ref35","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1002\/ana.27123","article-title":"Sex modifies the severity and outcome of spontaneous intracerebral hemorrhage","volume":"97","author":"Rivier","year":"2025","journal-title":"Ann Neurol"},{"key":"2026063005564198700_ref36","doi-asserted-by":"publisher","first-page":"e032595","DOI":"10.1161\/JAHA.123.032595","article-title":"Sex differences in the epidemiology of intracerebral hemorrhage over 10\u2009years in a population-based stroke registry","volume":"13","author":"Foschi","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"2026063005564198700_ref37","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1161\/strokeaha.114.007682","article-title":"Sex differences in incidence, pathophysiology, and outcome of primary intracerebral hemorrhage","volume":"46","author":"Gokhale","year":"2015","journal-title":"Stroke"},{"key":"2026063005564198700_ref38","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1038\/s41371-023-00801-5","article-title":"Hypertension: sex-related differences in drug treatment, prevalence and blood pressure control in primary care","volume":"37","author":"Bager","year":"2023","journal-title":"J Hum Hypertens"},{"key":"2026063005564198700_ref39","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1089\/jwh.2021.0577","article-title":"Sex differences in treatment and prognosis of acute intracerebral hemorrhage","volume":"32","author":"Broberg","year":"2023","journal-title":"J Womens Health"}],"container-title":["European Stroke Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/11\/6\/aakag069\/68559051\/aakag069.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/11\/6\/aakag069\/68559051\/aakag069.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:17:10Z","timestamp":1782818230000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/esj\/article\/doi\/10.1093\/esj\/aakag069\/8711655"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":39,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,2]]}},"URL":"https:\/\/doi.org\/10.1093\/esj\/aakag069","relation":{},"ISSN":["2396-9873","2396-9881"],"issn-type":[{"value":"2396-9873","type":"print"},{"value":"2396-9881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,6]]},"article-number":"aakag069"}}