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[Comment] Predicting stroke risk in women: are inflammation and atherosclerosis enough?

Stroke risk evolves across the lifespan, with distinct sex-specific differences that remain underappreciated in both research and clinical practice.1 One of these differences is the higher incidence of ischaemic stroke in women younger than 35 years compared with men of the same age, attributed to reproductive and hormonal factors such as oestrogen exposure, pregnancy complications, and, possibly, migraine with aura.2 In contrast, men's stroke risk accelerates more rapidly in midlife, whereas in older age (typically 75 years and older), the risk in women again surpasses that in men—driven by longer life expectancy and a higher prevalence of specific risk factors, such as atrial fibrillation.

[Comment] Treatment of acute central retinal artery occlusion: light at the end of the tunnel?

The acute management of central retinal artery occlusion (CRAO) has shifted from eye-care providers (eg, optometrists and ophthalmologists) to stroke neurologists, with emphasis on hyperacute management, expedited diagnostic tests, and aggressive secondary prevention.1,2 Revascularisation of the ischaemic retina with thrombolysis is supported by anecdotal cases, open-label studies, and meta-analyses of observational data, suggesting that intravenous thrombolysis is a low-risk therapy in patients with acute CRAO.

[Editorial] Essential medicines for neurological disorders: updates, rejections, and the road ahead

Several updates relevant to neurologists and health-care professionals involved in the prevention and treatment of neurological diseases have been added to the WHO Model List of Essential Medicines (EML). The inclusion of drugs into “the world's most influential list of medicines” is a necessary step towards equitable access. WHO's aspiration is for most countries to have access to all essential medicines for neurological disorders by 2031, and more drugs need to be added to the list in upcoming revisions if this goal is to be fulfilled.

Considering Thrombolysis for Mild Stroke

The number of patients presenting to emergency departments with mild stroke (National Institutes of Health Stroke Scale [NIHSS] score 0-5) is substantial and seems to be increasing over time. Determining the acute reperfusion therapy approach in an individual patient has presented many challenges. These include the individualized nature of the functional impact of a particular mild deficit (eg, subtle nondominant hand weakness has more of an impact on function for a professional violinist than a retired person); cognitive effects, which are often underrecognized at emergent presentation; the risk of later neurological decline outside the eligible time window for lytic therapy; the potential for spontaneous recovery over time; and the small but real risk of symptomatic intracranial hemorrhage associated with lytic administration. Two pivotal trials, one by the National Institute of Neurological Disorders and Stroke (NINDS) and the European Cooperative Acute Stroke Study 3 (ECASS-3), both excluded patients with mild, nondisabling deficits (Table).

Leveraging the Brain to Design and Revise Interventions

Neuroimaging techniques have been increasingly used in research over the past couple of decades to try to better understand brain function and structure and how it relates to important outcomes of interest. Insights from the brain from functional magnetic resonance imaging (fMRI), electroencephalography, and functional near-infrared spectroscopy can be used to advance questions in clinical, developmental, cognitive, affective, and social contexts. Although examining the brain is not without its limitations, neuroimaging can be a powerful tool to gain access to information that is difficult or impossible to assess with other measures. This Editorial will focus on some examples of neuroimaging methods that have helped advance research questions with the hope that they inspire new interdisciplinary and multimethodological collaborations within the JAMA Pediatrics community.