{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T14:17:13Z","timestamp":1783693033830,"version":"3.55.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Sex differences in outcomes after acute ischemic stroke are well recognized, but mechanisms remain unclear. This study evaluates whether parenchymal brain volume (PBV), age, and final infarct volume explain sex-specific differences in poststroke disability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We analyzed a prospectively collected multicenter registry of acute ischemic stroke patients treated between 2015 and 2024. Automated pipelines quantified PBV from noncontrast computed tomography and diffusion-weighted imaging\u2013derived final infarct volume from 24- to 48-hour magnetic resonance imaging. With the primary outcome being 90-day functional independence (modified Rankin Scale score 0\u20132), sex-stratified logistic regression models evaluated its association with PBV. Stratified logistic and linear models examined sex-specific relationships among covariables, and interaction terms were added to assess effect modification by sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 1103 patients, 48% were women, the median age was 66 (interquartile range, 56\u201377), the median National Institutes of Health Stroke Scale score was 9 (interquartile range, 4\u201317), and the median diffusion-weighted imaging\u2013derived final infarct volume was 7.8 (interquartile range, 0.2\u201336.3). Functional independence at 90 days was achieved in 51.7% of men versus 44.9% of women (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.025). In univariable analyses, greater PBV was associated with higher odds of functional independence in both men (odds ratio [OR], 1.30 [95% CI, 1.11\u20131.53]) and women (OR, 1.35 [95% CI, 1.13\u20131.61]). After ruling out multicollinearity (mean variance inflation factor, 1.32), multivariable analyses showed a persistent association in men (adjusted odds ratio, 1.30 per 100 cm\n                      <jats:sup>3<\/jats:sup>\n                      [95% CI, 1.10\u20131.60]) but not in women (adjusted odds ratio, 1.10 [95% CI, 0.90\u20131.33]). Each decade of age reduced the odds of functional independence by 30% in women (adjusted odds ratio, 0.70 [95% CI, 0.62\u20130.79]) versus 15% in men (adjusted odds ratio, 0.85 [95% CI, 0.72\u20130.97];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      for interaction=0.019). In stratified analyses, age was associated with larger infarcts in women (+4.22\u2009cm\n                      <jats:sup>3<\/jats:sup>\n                      \/decade;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.033) but not in men ([95% CI, \u20134.75 to 2.91];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.637).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>PBV was independently associated with functional independence in men but not significantly in women, in whom stronger age-related associations with infarct size and severity may attenuate its effect. These findings highlight the relevance of sex and brain volume in outcome modeling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/svin.125.002217","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T09:01:27Z","timestamp":1780995687000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Sex Differences in the Protective Effect of Brain Volume: Age Attenuates Protection in Women"],"prefix":"10.1161","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4654-7397","authenticated-orcid":true,"given":"Javier","family":"Gomez-Farias","sequence":"first","affiliation":[{"name":"Department of Neurology, McGovern Medical School at UTHealth, Houston, TX (J.G.-F., N.M.L., J.N.S., B.K., H.M.A., R.B., M.K., F.K., E.A.L., R.W.R., L.D.M., 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