Chronic Subdural Hematoma in the Posterior Fossa Associated with Hearing Impairment during Warfarin Therapy, Improved by Middle Meningeal Artery Embolization: A Case Report.

Abstract

Chronic subdural hematoma (CSDH) in posterior fossa is rare, and its pathogenesis and treatment remain unclear. In this study, we report a case of a patient with CSDH in the posterior fossa who was taking warfarin and underwent middle meningeal artery (MMA) embolization successfully. A 59-year-old man taking warfarin for a mechanical aortic valve presented with a complaint of hearing impairment. He then developed headaches and was referred to our hospital after the previous physician identified CSDH above and below the left tentorium cerebelli on computed tomography (CT). We conducted MMA embolization with n-butyl-2-cyanoacrylate while continuing anticoagulation therapy. Right after the day of the surgery, symptoms of hearing impairment and right hemiplegia immediately improved. He was discharged after 10 days of hospitalization and was able to walk independently. His symptoms disappeared 20 days after surgery. There was no recurrence 100 days after surgery. In this study, we experienced a case of a CSDH in the posterior fossa that was clinically improved by MMA embolization. MMA embolization is a useful option for nonspecific CSDH without interruption of warfarin therapy.