Delayed cognitive decline commonly occurs following intracerebral hemorrhage (ICH), but the mechanisms underlying this phenomenon remain obscure. We therefore investigated the potential mechanisms responsible for impaired cognitive function in a mouse collagenase model of ICH. Following recovery of motor and sensory deficits in the chronic phase of ICH, we noted significant cognitive impairment, which was assessed by the Morris water maze. This finding was accompanied by reduced dendrite spine density of ipsilateral hippocampal CA1 neurons. Reduced synaptic plasticity, manifested by impaired long‐term potentiation in hippocampal neurons, was also evident in both ipsilateral and contralateral hemispheres, suggesting that ICH also induces functional alterations in distal brain regions remote from the site of injury. In addition, the accumulation of microglia, infiltration of peripheral immune cells, and generation of reactive oxygen species were observed in both contralateral and ipsilateral hemispheres up to 5 wk post‐ICH. Furthermore, depletion of microglia using PLX3397, which inhibits colony stimulating factor 1 receptor, ameliorated this delayed cognitive impairment. Collectively, these results suggest that persistent and diffuse brain inflammation may contribute to cognitive impairment in the chronic stage of ICH recovery.—Shi, E., Shi, K., Qiu, S., Sheth, K. N., Lawton, M. T., Ducruet, A. F. Chronic inflammation, cognitive impairment, and distal brain region alteration following intracerebral hemorrhage. FASEB J. 33, 9616–9626 (2019). www.fasebj.org

Background: Intracranial aneurysms (IAs) are classified based on size (maximal dome diameter) as well as additional parameters such as neck diameter and dome-to-neck ratio (DNR). The neurosurgical literature includes a wide variety of definitions for both IA size and neck classifications. Standardizing the definitions of IA size and wide-neck classifications would help eliminate inconsistencies and potential misunderstandings of aneurysm morphology and rupture risk. Methods: We queried the MEDLINE (EBSCO) database using the terms “unruptured IA” and (“small” or “medium” or “large”) and filtered based on publication date, language, and scholarly journals. The resulting articles and their references were further screened for eligibility. This identified 286 records, of which 104 were excluded, leaving 182 articles for analysis. The review found several different IA size classifications and neck classifications. Results: A review of the existing literature describing size and neck classifications revealed 13 size classifications for small aneurysms, four classifications for medium aneurysms, 15 classifications for large aneurysms, and one classification for giant aneurysms. There were also seven different wide-neck classifications found. Conclusion: It is imperative that a standardization in classification be implemented to help interventionalists make the most informed decisions regarding emerging treatment options as new endovascular technologies and devices are emerging with indications based around these classifications. Based on the database findings, this article recommends standardized quantitative measurement ranges for IA size and neck classifications.

Background: Chronic subdural hematoma is associated with high rates of perioperative complications and recurrence. Methods: The classic treatments are observation or surgical evacuation. Middle meningeal artery embolization is a recently emerging procedure that has evolved as the neuroendovascular community has gained collective experience. This review summarizes the pathophysiology of chronic subdural hematoma, reviews the classic treatment strategies, discusses the advent and use of middle meningeal artery embolization, and describes the contemporary technical approach to middle meningeal artery embolization. Results: Embolization has the advantages of targeting the vascular supply of the neomembranes implicated in chronic subdural hematoma pathophysiology and avoiding surgical or bedside drainage in a population associated with significant comorbidities. Conclusions: Middle meningeal artery embolization is increasingly used both as an adjunct treatment to surgical evacuation and as a stand‐alone method for managing this challenging entity.

Vascular dysfunction resulting in compromised blood-brain barrier (BBB) integrity is evident in aging and disease. Although the complement C3a/C3a receptor (C3a/C3aR) axis influences normal brain aging and disease progression, the mechanisms governing endothelial C3aR–mediated neurovascular inflammation and BBB permeability remain unexplored. In this issue of the JCI, Propson et al. investigated endothelial C3a/C3aR signaling in normal, aged, and neurodegenerative mouse models. Endothelial C3aR signaling modulated age-dependent increases in VCAM1, initiated peripheral lymphocyte infiltration, and enhanced microglial activity. Increased calcium release downstream of C3aR signaling disrupted the vascular endothelial cadherin (VE-cadherin) junctions, increased BBB permeability, and degraded vascular structure and function. Mice lacking C3aR (C3ar1^–/–) and mice treated with a C3aR antagonist showed attenuated age-related microglial reactivity and neurodegeneration. These results confirm that complement-mediated signaling impacts vascular health and BBB function in normal aging and neurodegenerative disease, suggesting that complement inhibitors represent a therapeutic option for cerebral microvascular dysfunction.

Background The ideal treatment for unruptured vertebral artery dissecting aneurysms (VADAs) and ruptured dominant VADAs remains controversial. We report our experience in the management and endovascular treatment of patients with VADAs. Methods Patients treated endovascularly for intradural VADAs at a single institution from January 1, 1999, to December 31, 2019, were retrospectively reviewed. Primary neurological outcomes were assessed using modified Rankin Scale (mRS) scores, with mRS >2 considered a poor neurological outcome. Additionally, any worsening (increase) in the mRS score from the preoperative neurological examination was considered a poor outcome. Results Ninety-one patients of mean (SD) age 53 (11.6) years (48 (53%) men) underwent endovascular treatment for VADAs. Fifty-four patients (59%) presented with ruptured VADAs and 44 VADAs (48%) involved the dominant vertebral artery. Forty-seven patients (51%) were treated with vessel sacrifice of the parent artery, 29 (32%) with flow diversion devices (FDDs), and 15 (17%) with stent-assisted coil embolization (stent/coil). Rates of procedural complications and retreatment were significantly higher with stent/coil treatment (complications 4/15; retreatment 6/15) than with vessel sacrifice (complications 1/47; retreatment 2/47) or FDD (complications 2/29; retreatment 4/29) (p=0.008 and p=0.002, respectively). Of 37 patients with unruptured VADAs treated, only two (5%) had mRS scores >2 on follow-up. Conclusion Endovascular FDD treatment of VADAs appears to be associated with lower retreatment and complication rates than stenting/coiling, although further study is required for confirmation. Endovascular treatment of unruptured VADAs was safe and was associated with favorable angiographic and neurological outcomes.