Pregnancy and menopause affect risk of brain haemorrhage in women

An international consortium of experts in the field led by professor Marieke Wermer, chair of the department of Neurology of the UMCG, showed in this week’s issue of the Lancet Neurology that women more often suffer from hemorrhagic stroke and are more severely affected than men. Also, there are a worrisome number of female specific knowledge gaps for example on the risk of delivery in women with intracranial aneurysms and the effects of hormonal replacement therapy on the risk of intracerebral hemorrhage. The article is a call to action to more research and funding for this important topic. 

May is Stroke awareness month. Stroke is one of the most disabling diseases in the world affecting more than 13 million people every year. Hemorrhagic stroke (including intracerebral hemorrhage and subarachnoid hemorrhage caused by an intracranial aneurysm) are an important contributors of the immense global burden of stroke. There is increasing scientific attention for sex differences in onset, symptomatology and pathophysiology of stroke but until now relatively sparse information was present for sex differences in brain hemorrhages and a high quality review on the topic was missing. 

Wermer supervised the project, together with dr. Ruigrok from the UMCU, that further was performed by PhD student and first author Mariam Ali from Leiden in collaboration with other experts from the Netherlands, Canada, Norway and France. They conclude that female-specific risk factors such as pregnancy, eclampsia or pre-eclampsia, post-menopausal status and hormone therapy influence a woman’s long-term risk of hemorrhagic stroke. The presence of brain vascular malformations poses unique clinical dilemmas during pregnancy and delivery. In the absence of guidelines, multidisciplinary teams should carefully assess the risks and benefits for these patients. 

Because of Stroke awareness month, the new issue of the Lancet Neurology is fully attributed to advances in stroke research. Besides the review, professor Wermer also wrote a comment in the same issue addressing treatment of intracerebral hematoma expansion and co-authored a paper on the results of the Dutch Truth trial on the effect of blood pressure lowering in ischemic stroke. The issue can be found on the Lancet Neurology website