Middle meningeal artery embolization for chronic subdural hematoma in a young patient with antiphospholipid syndrome: A case report.

Abstract

Chronic subdural hematoma is a common condition in neurosurgical practice. It is usually treated by burr-hole surgery. Patients with coagulopathies such as antiphospholipid syndrome, are at increased risk of complications, and careful consideration of the patient's specific risk of both bleeding and thromboembolic complications must guide medical management. We present the case of a 34-year-old who presented to the neurosurgical department with a chronic subdural hematoma. She had a medical history of triple-positive antiphospholipid syndrome, lupus, and mechanical aortic valve replacement due to Libman-Sacks endocarditis. It was considered of high risk to proceed with traditional burr-hole surgery, so instead embolization of the middle meningeal artery was performed. Postoperatively the patient gradually improved, and a scan at 6 months showed complete regression of the hematoma. She later presented with a contralateral subdural hematoma, which was also successfully treated with middle meningeal artery embolization. Unfortunately, she suffered from an intracerebral hemorrhage shortly afterward, which was treated conservatively by careful management of her anticoagulant therapy. She has now made a full recovery at 4 months follow-up.