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In This Issue of JAMA Neurology
March 2017

Highlights

JAMA Neurol. 2017;74(3):253. doi:10.1001/jamaneurol.2016.3984

Research

Mechanical thrombectomy (MT) improves clinical outcomes in patients with acute ischemic stroke (AIS) caused by a large vessel occlusion. However, it is not known whether intravenous thrombolysis (IVT) is of added benefit in patients undergoing MT. Coutinho et al examined whether treatment with IVT before MT with a stent retriever is beneficial in patients undergoing MT. Their results indicate that treatment of patients experiencing AIS due to a large vessel occlusion with IVT before MT does not appear to provide a clinical benefit over MT alone. A randomized clinical trial seems warranted. Editorial perspective is provided by Gursant S. Atwal, MD, and Adnan H. Siddiqui, MD, PhD.

Editorial

CME

There is a growing number of therapies that could be administered after the first symptom of central nervous system demyelination. These drugs can delay multiple sclerosis (MS) diagnosis and slow down future disability. However, treatment of patients with benign course may not be needed; therefore, there is a need for biomarkers to predict long-term prognosis in patients with clinically isolated syndrome (CIS). Van der Vuurst de Vries et al investigated whether the T-cell activation marker soluble CD27 (sCD27) measured in cerebrospinal fluid of patients at time of a first attack is associated with a subsequent diagnosis of MS and a higher relapse rate. They found that sCD27 in cerebrospinal fluid of patients with CIS was associated with MS diagnosis and a high relapse rate. Editorial perspective is provided by Jeffrey M. Gelfand, MD, MAS.

Editorial

Although patients with dementia with Lewy bodies (DLB) have shorter disease duration than patients with Alzheimer disease dementia, little is known about which factors influence disease duration among patients with DLB. In an observational study using the National Alzheimer Coordinating Center database, Graff-Radford and coauthors identified pathologic correlates of disease duration in 807 participants with transitional or diffuse Lewy body disease (LBD). They found that diffuse LBD was associated with shorter disease duration compared with transitional LBD.

CME

Childhood arterial ischemic stroke (CAIS) affects approximately 1.6 per 100 000 children per year, while stroke recurs in up to 20% of patients at 5 years. Factors determining the risk of recurrence are incompletely understood. Uohara and coauthors investigated the incidence of the recurrence of CAIS in the posterior and anterior circulations to determine if the risk differs between the 2 locations. They identified a subgroup of patients that comprise more than 80% of recurrences of CAIS. Three years after incident stroke, 19% of children with posterior circulation CAIS had a recurrence compared with 4% of patients with anterior circulation CAIS. Different mechanisms of stroke may account for this difference.

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