Gender & Traumatic Brain Injury

Sex Differences in the Brain

Watch Watch Dr. Harris discussing TBI at Stanford's Sports Concussion Summit.

Health Care Advocacy

Dr. Adamson discusses sleep for brain health and performance.

Female Brain Injury, Neurobiology and Trauma  Symposium focused on reviewing the scientific evidence of female brain injury, call for more sex/gender research, and increase awareness in the medical community, social media and the press.

Intimate Partner Violence

Watch Dr. Adamson speak on the topic of intimate partner violence and head injuries.

Casual Conversations

Dr. Adamson describes traumatic brain injury in women.

Brain Injury Conference

Brain Injury Professional

Watch Dr. Adamson discussing the impact of traumatic brain injury in females.

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Goal of the event is to cross-pollination of data and research from sports, domestic violence, trauma, and military service; fill the analysis gap of what is known (and not known) about female brain injury (concussions and TBI) spanning “cradle to grave”.

Gender, TBI & Cortical

Sex differences in cortical thickness and diffusion properties in patients with traumatic brain injury: a pilot study

Maheen M AdamsonKeith MainOdette A HarrisXiaojian Kang

Objective: Cortical thickness and diffusion properties are important measures of gray and white matter integrity in those with traumatic brain injury (TBI). Many studies show that healthy adult females have greater cortical thickness than males across numerous brain sites. In this study, we explored this sex difference in patients with TBI.

Method: Participants consisted of 32 patients with TBI and 21 neurologically healthy controls. All were scanned by magnetic resonance imaging (MRI). Differences in cortical thickness and diffusion properties were examined between groups (i.e., TBI/control, male/female).

Results: Patients with TBI had more cortical thinning (both hemispheres) compared to controls. They also showed decreased fractional anisotropy (FA) for several major white matter tracts. Healthy females had significantly greater cortical thickness compared to healthy males. However, this difference was smaller among the patients with TBI. We found no sex differences in diffusion properties. There were moderate correlations between cortical thickness, diffusion properties, and cognitive performance, as measured by the Trail Making Test B.

Conclusion: These findings contribute to a growing discussion on sex differences in cortical thickness and diffusion properties. Sexual dimorphism could necessitate different clinical profiles, targets, and rehabilitation strategies in patients with TBI.

Gender & TBI in the Military

Sex differences in symptom presentation and functional outcomes: a pilot study in a matched sample of veterans with mild TBI. 

Max GrayMaheen M AdamsonRyan C ThompsonKristopher KapphahnSummer HanJoyce S ChungOdette A Harris

Primary Objective: Research focused on mild traumatic brain injury in active military and veteran populations details the psychological, neurological and functional outcomes of mTBI, in a primarily male (~95%) cohort. This may misrepresent female symptoms and outcomes. Here we assess for genuine sex differences in symptom presentation and functional outcomes.

Research Design: We used matched pairs to preclude potential sex bias in outcome data.

Methods and Procedures: We matched 49 female/male pairs on; 1) mechanism of injury, 2) time from injury to assessment and 3) age at assessment. Statistics were t-tests, chi-square, correlations and post hoc linear regression.

Main outcomes and results: Outcome assessment revealed four significant (p < .05) sex differences; Living situation, Marital status, Vocation and Branch of service. Only the Neurobehavioral Symptom Inventory (NSI) composite cognitive domain factor was significantly different between females (mean: 10.26) and males (mean: 7.58). Linear regression confirmed a significant effect of sex for the cognitive composite (p = .002).

Conclusion: We conclude that sex has a moderate effect on mTBI post-concussive symptom presentation. The significant sex difference in the NSI cognitive domain characterizes sex-related symptomology profiles providers can focus on for better rehabilitation management. Replication in the larger cohort would improve generalizability.

Gender, TBI & Neuromodulation

Sex Differences in Neuromodulation Treatment Approaches for Traumatic Brain Injury: A Scoping Review

Angela Phillips , Sohrab SamiMaheen Adamson

Objective: Neuromodulatory brain stimulation interventions for traumatic brain injury (TBI)-related health sequelae, such as psychiatric, cognitive, and pain disorders, are on the rise. Because of disproportionate recruitment and epidemiological reporting of TBI-related research in men, there is limited understanding of TBI development, pathophysiology, and treatment intervention outcomes in women. With data suggesting sex-related variances in treatment outcomes, it is important that these gaps are addressed in emerging, neuromodulatory treatment approaches for TBI populations.

Methods: Four research databases (PubMED, EMBASE, CINAHL, and PsycINFO) were electronically searched in February 2020.

Design: This PRISMA Scoping Review (PRISMA-ScR)-guided report contextualizes the importance of reporting sex differences in TBI + neuromodulatory intervention studies and summarizes the current state of reporting sex differences when investigating 3 emerging interventions for TBI outcomes.

Results: Fifty-four studies were identified for the final review including 12 controlled trials, 16 single or case series reports, and 26 empirical studies. Across all studies reviewed, 68% of participants were male, and only 7 studies reported sex differences as a part of their methodological approach, analysis, or discussion.

Conclusion: This review is hoped to update the TBI community on the current state of evidence in reporting sex differences across these 3 neuromodulatory treatments of post-TBI sequelae. The proposed recommendations aim to improve future research and clinical treatment of all individuals suffering from post-TBI sequelae.

Neurological Focus

Traumatic brain injury among female veterans: a review of sex differences in military neurosurgery

Lily H. KimJennifer L. QuonFelicia W. SunKristen M. WortmanMaheen M. AdamsonOdette A. Harris

The impact of traumatic brain injury (TBI) has been demonstrated in various studies with respect to prevalence, morbidity, and mortality data.

Many of the patients burdened with long-term sequelae of TBI are veterans.

Although fewer in number, female veterans with TBI have been suggested to suffer from unique physical, mental, and social challenges.

However, there remains a significant knowledge gap in the sex differences in TBI.

Increased female representation in the military heralds an increased risk of TBI for female soldiers, and medical professionals must be prepared to address the unique health challenges in the face of changing demographics among the veteran TBI population.

In this review, the authors aimed to present the current understanding of sex differences in TBI in the veteran population and suggest directions for future investigations.