Elizabeth Wilson Mayne

All Publications

• Blockade of VCAM1 or VLA4 promotes normal cerebrovasculature and prevents cognitive decline late after stroke Zera, K., Bradshaw, K., Zhu, L., Hahn, O., Foltz, A., Peterson, T., Yousef, H., Lee, D., Mayne, E., Wyss-Coray, T., Buckwalter, M. LIPPINCOTT WILLIAMS & WILKINS. 2026

  View details for DOI 10.1161/str.57.suppl_1.DP197

  View details for Web of Science ID 001690957400025

• Stroke in children with congenital or acquired heart disease. Current opinion in pediatrics Mayne, E. W. 2025; 37 (6): 591-596

  Abstract

  Children with congenital or acquired cardiac disease are at increased risk for both ischemic and hemorrhagic stroke. This review covers the epidemiology, presentation, acute management, and outcomes of stroke in children with heart disease.The major advances in endovascular thrombectomy for adults with large vessel occlusions (LVOs) have had significant ramifications for children with cardioembolic stroke, who often present with LVO. Several large registry studies have shown that thrombectomy likely improves outcomes for children with LVO, including those with acquired or congenital heart disease. Improving both primary and secondary stroke prevention remains both vital and challenging; as more children with congenital heart disease survive into adulthood, studies show that they remain at increased risk for stroke and may be susceptible to earlier frailty and cognitive impairment.Children with cardiac disease have a lifelong increased risk of stroke. While new interventions such as thrombectomy may improve outcomes, more research is needed to improve long term neurologic outcomes in this population.

  View details for DOI 10.1097/MOP.0000000000001517

  View details for PubMedID 41190401

• Blood Pressure Management and Postoperative Stroke Risk in Pediatric Moyamoya Disease. Pediatric neurology Pal, R., Cheronis, C., Mayne, E., Steinberg, G. K., Lee, S. 2025; 175: 19-26

  Abstract

  To assess variability in postoperative blood pressure management and its association with stroke incidence in pediatric Moyamoya disease (MMD) patients undergoing surgical revascularization.This retrospective cohort study was conducted at Stanford University Medical Center from 1992 to 2023. It included 109 pediatric MMD patients (≤18 years) who underwent revascularization surgery. The study the study evaluated outpatient systolic blood pressures, inpatient mean arterial pressure targets, and the use of vasoactive medications.Postoperative blood pressure management varied significantly based on patient age, syndrome group, and preoperative stroke status. There was no correlation between preoperative systolic blood pressure and postoperative blood pressure targets. Vasoactive medications were used in 55% of patients intravenously and 53% orally, often for extended durations, but without a clear association with transient neurological symptoms. Major strokes occurred in 6.4% of patients, primarily within the first postoperative week. Stroke incidence was associated with longer durations of vasoactive therapy (IV: 3.0 vs 0.0 days, P = 0.026; oral: 53.0 vs 0.0 days, P = 0.035), but not with specific blood pressure targets.There is significant variability in postoperative blood pressure management in pediatric MMD, reflecting the absence of standardized guidelines. The increased risk of stroke during the first postoperative week, particularly among patients receiving prolonged vasoactive therapy, underscores the need for prospective studies to establish individualized hemodynamic targets and reduce practice variability.

  View details for DOI 10.1016/j.pediatrneurol.2025.10.028

  View details for PubMedID 41265023

• Radiographic Severity of Neonatal Deep Medullary Venous Thrombosis Is Associated with Neurodevelopmental Impairment. The Journal of pediatrics Pal, R., Barsh, G. R., Luo, I., Dahmoush, H., Lee, S., Mayne, E. 2025: 114769

  Abstract

  OBJECTIVE: To evaluate the association between severity of brain MRI findings and neurodevelopmental impairment (NDI) among neonates with radiographically identified deep medullary vein thrombosis (DMVT) and to develop an MRI grading system to help predict clinical outcomes.STUDY DESIGN: We conducted a retrospective cohort study of infants admitted to a single, tertiary care hospital and diagnosed as having DMVT identified by brain MRI from January 1990 to March 2023. Clinical characteristics, MRI features, and neurodevelopmental assessments were analyzed. An MRI grading system was created to categorize the severity of radiographic injury as mild, moderate, or severe.RESULTS: Among 63 neonates diagnosed with DMVT, 41 exhibited moderate to severe MRI lesions. These patients were more likely to experience NDI than those with mild lesions (adjusted OR 24.3, 95% CI 4.7-180.2, p<0.001). Follow-up data were available for 52 infants, of whom 40.4% developed NDI. MRI severity emerged as the strongest predictor of impaired outcomes, independent of other clinical factors such as gestational age, Apgar score, or seizures at presentation.CONCLUSIONS: Neonates with moderate or severe DMVT on MRI are at risk for NDI. The proposed MRI grading system may be a valuable classification and prognostication tool for clinicians and researchers managing DMVT in neonates.

  View details for DOI 10.1016/j.jpeds.2025.114769

  View details for PubMedID 40783051

• Use of a Stroke Alert Protocol and Outcomes at a Quaternary Children's Hospital. The Journal of pediatrics Africk, B., Luo, I., Silverman, A., Teeyagura, P., Jackson, K., Gauna, J., Mayne, E., Lee, S. 2024: 114364

  Abstract

  OBJECTIVE: To assess for improvement in diagnostic efficiency following implementation of an institutional pediatric stroke alert protocol at a quaternary children's hospital, and to compare characteristics of in-hospital (IH) and out-of-hospital (OH) stroke alert activations.STUDY DESIGN: We retrospectively reviewed data from pediatric stroke alerts called for children between age 1 month to 21 years of age at our quaternary children's hospital between October 2016 and October 2022 after implementation of an institutional stroke alert protocol. Generalized linear models assessed code-to-image (CTI) time over the study period, with and without interaction terms for alert location. Demographic, clinical, and imaging characteristics between IH and OH alerts were compared using Fisher's exact test or Mann-Whitney U test.RESULTS: Of 206 total stroke activations, 129 (62.6%) occurred IH and 77 (37.4%) occurred OH. Overall mean CTI time decreased by 4.56 minutes per year (p = 0.007) after adjusting for confounders. The association between year and mean CTI time was significantly stronger for IH alerts (decrease of 8.33 minutes/year) compared with OH alerts (increase of 1.90 minutes/year). Subgroup analyses showed that CTI for computed tomography (CT) ± CT angiography and magnetic resonance imaging (MRI) without sedation improved, although CTI time for MRI with sedation did not change over time. IH/OH divergent trends were consistent for CT ± CTA and non-sedated MRI.CONCLUSION: After implementation of a pediatric stroke alert protocol, we observed a steady and significant improvement in CTI times for IH, but not OH alerts.

  View details for DOI 10.1016/j.jpeds.2024.114364

  View details for PubMedID 39428087

• Pediatric Stroke and Cardiac Disease: Challenges in Recognition and Management. Seminars in pediatric neurology Mayne, E. W., Mailo, J. A., Pabst, L., Pulcine, E., Harrar, D. B., Waak, M., Rafay, M. F., Hassanein, S. M., Amlie-Lefond, C., Jordan, L. C. 2022; 43: 100992

  View details for DOI 10.1016/j.spen.2022.100992

  View details for PubMedID 36344023

• Evaluation of Seizure Risk in Infants After Cardiopulmonary Bypass in the Absence of Deep Hypothermic Cardiac Arrest. Neurocritical care Levy, R. J., Mayne, E. W., Sandoval Karamian, A. G., Iqbal, M., Purington, N., Ryan, K. R., Wusthoff, C. J. 2021

  Abstract

  BACKGROUND: Guidelines recommend evaluation for electrographic seizures in neonates and children at risk, including after cardiopulmonary bypass (CPB). Although initial research using screening electroencephalograms (EEGs) in infants after CPB found a 21% seizure incidence, more recent work reports seizure incidences ranging 3-12%. Deep hypothermic cardiac arrest was associated with increased seizure risk in prior reports but is uncommon at our institution and less widely used in contemporary practice. This study seeks to establish the incidence of seizures among infants following CPB in the absence of deep hypothermic cardiac arrest and to identify additional risk factors for seizures via a prediction model.METHODS: A retrospective chart review was completed of all consecutive infants≤3months who received screening EEG following CPB at a single center within a 2-year period during 2017-2019. Clinical and laboratory data were collected from the perioperative period. A prediction model for seizure risk was fit using a random forest algorithm, and receiver operator characteristics were assessed to classify predictions. Fisher's exact test and the logrank test were used to evaluate associations between clinical outcomes and EEG seizures.RESULTS: A total of 112 infants were included. Seizure incidence was 10.7%. Median time to first seizure was 28.1h (interquartile range 18.9-32.2h). The most important factors in predicting seizure risk from the random forest analysis included postoperative neuromuscular blockade, prematurity, delayed sternal closure, bypass time, and critical illness preoperatively. When variables captured during the EEG recording were included, abnormal postoperative neuroimaging and peak lactate were also highly predictive. Overall model accuracy was 90.2%; accounting for class imbalance, the model had excellent sensitivity and specificity (1.00 and 0.89, respectively).CONCLUSIONS: Seizure incidence was similar to recent estimates even in the absence of deep hypothermic cardiac arrest. By employing random forest analysis, we were able to identify novel risk factors for postoperative seizure in this population and generate a robust model of seizure risk. Further work to validate our model in an external population is needed.

  View details for DOI 10.1007/s12028-021-01313-1

  View details for PubMedID 34322828

• Diminished Blood Pressure Profiles in Children With Down Syndrome. Hypertension (Dallas, Tex. : 1979) Santoro, J. D., Lee, S., Mlynash, M., Mayne, E. W., Rafii, M. S., Skotko, B. G. 2020: HYPERTENSIONAHA11914416

  Abstract

  This study sought to analyze blood pressure trends in children with Down syndrome at multiple centers. A multicenter, retrospective, cross-sectional study was performed. All patients were <18 years and had a diagnosis of Down syndrome. Existing comorbidities were nonexclusionary. For each patient, 3 blood pressure recordings were obtained from routine clinic visits. In total, 887 patients with 2661 total blood pressure recordings were included in this study. The average blood pressure percentile for patients was 38.87 with a median percentile of 31.5. Age, sex, and race were not predictive of blood pressure percentile. Compared with established data from the National Heart Lung and Blood Institute and National Health and Nutrition Examination Survey cohort (ages 8-18 years), blood pressure in our Down syndrome population was statistically lower by 6.1 percentile points (P<0.001), with the greatest difference at higher blood pressure percentiles (P<0.001). Only 10% of all Down syndrome cohort blood pressure recordings were greater than the National Heart Lung and Blood Institute/National Health and Nutrition Examination Survey 70th percentile, with no patients meeting criteria for prehypertension or hypertension. Additional comparisons against American Academy of Pediatrics data were similar and statistically significant. In children with Down syndrome, there is a 12 percentile point reduction in baseline blood pressure compared with age- and height-matched controls reported in the National Heart Lung and Blood Institute/National Health and Nutrition Examination Survey and American Academy of Pediatrics cohorts. This data can potentially be utilized in the evaluation and care of persons with Down syndrome in their pediatric medical homes.

  View details for DOI 10.1161/HYPERTENSIONAHA.119.14416

  View details for PubMedID 31928114

• Blood Pressure Elevation and Risk of Moyamoya Syndrome in Patients With Trisomy 21 PEDIATRICS Santoro, J. D., Lee, S., Mlynash, M., Thuy Nguyen, Lazzareschi, D. V., Kraler, L. D., Mayne, E. W., Steinberg, G. K. 2018; 142 (4)

  View details for DOI 10.1542/peds.2018-0840

  View details for Web of Science ID 000449034300026

• Blood Pressure Elevation and Risk of Moyamoya Syndrome in Patients With Trisomy 21. Pediatrics Santoro, J. D., Lee, S., Mlynash, M., Nguyen, T., Lazzareschi, D. V., Kraler, L. D., Mayne, E. W., Steinberg, G. K. 2018

  Abstract

  OBJECTIVES: Individuals with Down syndrome (DS) are at risk for the development of moyamoya syndrome (MMS); MMS is often recognized only after a resulting stroke has occurred. Our goal with this study was to determine if elevations in blood pressure (BP) precede acute presentation of MMS in individuals with DS.METHODS: A single-center, retrospective case-control study was performed. Thirty patients with MMS and DS and 116 patients with DS only were identified retrospectively. Three BP recordings were evaluated at set intervals (18-24 months, 12-18 months, and 6-12 months before diagnosis of MMS). These were then compared against control averages from patients with DS only. To assess changes over the time, we used general linear model repeated measures analysis of variance. To identify independent predictors of MMS and DS, we used a multivariable analysis using generalized estimating equations accounting for repeated measures of BP.RESULTS: BP in patients with MMS and DS rose significantly over the 24-month period preceding presentation (34th, 42nd, and 70th percentiles at the 18-24-month, 12-18-month, and 6-12-month periods, respectively). BPs in the patients with both MMS and DS were significantly higher than in the DS-only controls in the 6 to 12 (P < .001) and 12 to 18 months before presentation (P = .016). Higher Suzuki scores, bilateral disease, and posterior circulation involvement were also predictive of BP elevation before presentation.CONCLUSIONS: Elevations in BP may foreshadow presentation of MMS in individuals with DS. This simple, low-cost screening measure may lead to early identification of at-risk patients in the medical home and prevent irreversible neurologic injury.

  View details for PubMedID 30190347

• Dopamine suppresses persistent network activity via D1-like dopamine receptors in rat medial entorhinal cortex EUROPEAN JOURNAL OF NEUROSCIENCE Mayne, E. W., Craig, M. T., McBain, C. J., Paulsen, O. 2013; 37 (8): 1242–47

  Abstract

  Cortical networks display persistent activity in the form of periods of sustained synchronous depolarizations ('UP states') punctuated by periods of relative hyperpolarization ('DOWN states'), which together form the slow oscillation. UP states are known to be synaptically generated and are sustained by a dynamic balance of excitation and inhibition, with fast ionotropic glutamatergic excitatory and GABAergic inhibitory conductances increasing during the UP state. Previously, work from our group demonstrated that slow metabotropic GABA receptors also play an important role in terminating the UP state, but the effects of other neuromodulators on this network phenomenon have received little attention. Given that persistent activity is a neural correlate of working memory and that signalling through dopamine receptors has been shown to be critical for working memory tasks, we examined whether dopaminergic neurotransmission affected the slow oscillation. Here, using an in vitro model of the slow oscillation in rat medial entorhinal cortex, we showed that dopamine strongly and reversibly suppressed cortical UP states. We showed that this effect was mediated through D1 -like and not D2 -like dopamine receptors, and we found no evidence that tonic dopaminergic transmission affected UP states in our model.

  View details for DOI 10.1111/ejn.12125

  View details for Web of Science ID 000317850800004

  View details for PubMedID 23336973

  View details for PubMedCentralID PMC3628042

• Distinct roles of GABAB1a- and GABAB1b-containing GABAB receptors in spontaneous and evoked termination of persistent cortical activity. The Journal of physiology Craig, M. T., Mayne, E. W., Bettler, B., Paulsen, O., McBain, C. J. 2013; 591 (4): 835-43

  Abstract

  During slow-wave sleep, cortical neurons display synchronous fluctuations between periods of persistent activity ('UP states') and periods of relative quiescence ('DOWN states'). Such UP and DOWN states are also seen in isolated cortical slices. Recently, we reported that both spontaneous and evoked termination of UP states in slices from the rat medial entorhinal cortex (mEC) involves GABA(B) receptors. Here, in order to dissociate the roles of GABA(B1a)- and GABA(B1b)-containing receptors in terminating UP states, we used mEC slices from mice in which either the GABA(B1a) or the GABA(B1b) subunit had been genetically ablated. Pharmacological blockade of GABA(B) receptors using the antagonist CGP55845 prolonged the UP state duration in both wild-type mice and those lacking the GABA(B1b) subunit, but not in those lacking the GABA(B1a) subunit. Conversely, electrical stimulation of layer 1 could terminate an ongoing UP state in both wild-type mice and those lacking the GABA(B1a) subunit, but not in those lacking the GABA(B1b) subunit. Together with previous reports, indicating a preferential presynaptic location of GABA(B1a)- and postsynaptic location of GABA(B1b)-containing receptors, these results suggest that presynaptic GABA(B) receptors contribute to spontaneous DOWN state transitions, whilst postsynaptic GABA(B) receptors are essential for the afferent termination of the UP state. Inputs to layer 1 from other brain regions could thus provide a powerful mechanism for synchronizing DOWN state transitions across cortical areas via activation of GABAergic interneurons targeting postsynaptic GABA(B) receptors.

  View details for DOI 10.1113/jphysiol.2012.248088

  View details for PubMedID 23266934

  View details for PubMedCentralID PMC3591701