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In This Issue of JAMA Neurology
April 2019


JAMA Neurol. 2019;76(4):389. doi:10.1001/jamaneurol.2018.2981

Optimal clinical outcomes for patients with acute ischemic stroke treated with endovascular therapy hinges on timely reperfusion; however, existing data are scarce. In this meta-analysis of data from 728 patients in 7 randomized trials of the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) group, Bourcier and coauthors found that the rate of successful reperfusion decreased as time elapsed after arrival at the stroke endovascular center. Fast reperfusion was a major modifiable factor associated with better clinical outcome, and the intermediary outcome, the rate of successful reperfusion, was higher with faster in-hospital process times.

Understanding how spaceflight affects the human brain and behavior is essential to future long-duration space exploration in addition to the health of current astronauts. In a retrospective longitudinal analysis of diffusion magnetic resonance imaging of 15 astronauts with both preflight and postflight imaging, Lee and coauthors found that spaceflight was associated with a significant decrease in extracellular fluid around the top of the brain and widespread increases in the inferior frontal, temporal, and occipital lobes. White matter declined at a faster rate than expected with healthy aging, ranging from 0.75% to 1.25%. These brain changes were associated with spaceflight mission duration, the total number of missions experienced, and transient preflight to postflight declines in balance. A Viewpoint by Roberts and Petersen provides insight into hydrocephalus and space flight. Editorial perspective is provided by Bagian.



Although stroke is a common cause of mortality and disability in the United States, data on the clinical characteristics and outcomes of Asian American individuals who experience stroke have not been fully explored. In a large retrospective analysis from 2171 Get With The Guidelines–Stroke hospitals, Song and coauthors compared clinical characteristics, outcomes, and treatment of 1 707 962 white patients with acute ischemic stroke with 64 337 Asian American patients with acute ischemic stroke. In patients with acute ischemic stroke, Asian American ethnicity was associated with greater stroke severity and less intravenous thrombolysis compared with white race. Despite receiving less thrombolysis, Asian American patients had more subsequent hemorrhagic complications and were less likely to be disability free at discharge.

Studies of the general health of individuals with tics are rare. Brander and coauthors conducted a longitudinal population-based cohort study of 7804 individuals with Tourette syndrome or chronic tic disorder and showed that these individuals are at much higher risk of developing metabolic and cardiovascular disorders compared with the general population and their unaffected full siblings. These results highlight the importance of carefully monitoring cardiometabolic health in these patients and considering more proactive interventions when indicated.