Background We have previously studied possible gender-related differences in intracranial hypertension and outcome following head injury. The results were always close to the limit of significance so that to achieve greater statistical power we have continued recruitment of patients for further 5 years. Methods Head injury patients (612) who were sedated and ventilated were studied from 1992—2007. All had intracra-nial pressure (ICP), arterial blood pressure (ABP) and cerebral perfusion pressure (CPP) monitored continuously. Patients' outcome was assessed at 6 months post-injury (469 were available for follow-up).
Results This retrospective analysis enrolled 98 females and 371 males. Males and females were well matched for age (mean±standard deviation: 33±17 and 33±16 years respectively) and the initial median Glasgow Coma Score (GCS) [females and males 6]. The difference in mortality rate between sexes was age-related. In the subgroup of patients younger than 50 years mortality was 17% in males and 29% in females (p=0.026), whereas there was no difference above 50 years (around 40% both males and females). Mean ICP, CPP and ABP were not different between males and females. However, cerebrovascular pressure reactivity was found to be significantly worse in females than in males in the age group below 50 years (PRx; males: 0.044±0.031; females 0.11±0.047; p<0.05). Conclusion Following head injury females younger than 50 have a significantly worse pressure reactivity and greater mortality rate than males of the same age.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Alkayed NJ, Harukuni I, Kimes AS, London ED, Traystman RJ, Hurn PD (1998) Gender-linked brain injury in experimental stroke. Stroke 29:159–165
Balestreri M, Czosnyka M, Steiner LA, Schmidt E, Smielewski P, Matta B, Pickard JD (2004) Intracranial hypertension: what additional information can be derived from ICP waveform after head injury? Acta Neurochir (Wien) 146:131–141
Balestreri M, Steiner LA, Czosnyka M (2003) Sex-related differences and traumatic brain injury. J Neurosurg 99(3):616
Bramlett HM, Dietrich WD (2001) Neuropathological protection after traumatic brain injury in intact female rats versus males or ovariectomized females. J Neurotrauma 18:891–900
Coimbra R, Hoyt DB, Potenza BM, Fortlage D, Hollingsworth-Fridlund P (2003) Does sexual dimorphism influence outcome of traumatic brain injury patients? The answer is no!. J Trauma 54:689–700
Czosnyka M, Balestreri M, Steiner L, Smielewski P, Hutchinson PJ, Matta B, Pickard JD (2005) Age, intracranial pressure, autoregula-tion, and outcome after brain trauma. J Neurosurg 102(3):450–454
Deitch EA, Livingston DH, Lavery RF, Monaghan SF, Bongu A, Machiedo GW (2007) Hormonally active women tolerate shock-trauma better than do men: a prospective study of over 4000 trauma patients. Ann Surg 246(3):447–455
Farin A, Deutsch R, Biegon A, Marshall LF (2003) Sex-related differences in patients with severe head injury: greater susceptibility to brain swelling in female patients 50 years of age and younger. J Neurosurg 98:32–36
Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ (2002) Specialist neurocritical care and outcome from head injury. Intensive Care Med 28:547–553
Singer CA, Rogers KL, Strickland TM, Dorsa DM (1996) Estrogen protects primary cortical neurons from glutamate toxicity. Neurosci Lett 212:13–16
Smielewski P, Czosnyka M, Steiner L, Belestri M, Piechnik S, Pickard JD (2005) ICM+: software for on-line analysis of bedside monitoring data after severe head trauma. Acta Neurochir Suppl; 95:43–49
Steiner LA, Czosnyka M, Piechnik SK, Smielewski P, Chatfield D, Menon DK, Pickard JD (2002) Continuous monitoring of cerebro-vascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med 30(4):733–738
Author information
Authors and Affiliations
Editor information
Rights and permissions
Copyright information
© 2008 Springer-Verlag/Wien
About this paper
Cite this paper
Czosnyka, M. et al. (2008). Gender-related differences in intracranial hypertension and outcome after traumatic brain injury. In: Steiger, H.J. (eds) Acta Neurochirurgica Supplements. Acta Neurochirurgica Supplementum, vol 102. Springer, Vienna. https://doi.org/10.1007/978-3-211-85578-2_5
Download citation
DOI: https://doi.org/10.1007/978-3-211-85578-2_5
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-85577-5
Online ISBN: 978-3-211-85578-2
eBook Packages: MedicineMedicine (R0)