J Cerebrovasc Endovasc Neurosurg.  2018 Mar;20(1):40-46. 10.7461/jcen.2018.20.1.40.

Usefulness of Middle Meningeal Embolization to Prevent Recurrent Spontaneous Chronic Subdural Hemorrhage

• Sirh S
• Park HR
• Park SQ

• KMID: 2422559
• DOI: http://doi.org/10.7461/jcen.2018.20.1.40

Abstract

Spontaneous chronic subdural hematoma (SDH) is a rare condition that could develop in association with hematologic disease. A 66-year-old male developed a chronic SDH as an initial manifestation of chronic myelomonocytic leukemia (CMML). He experienced recurrent chronic subdural hemorrhage and newly developed intracerebral hemorrhage. Considering the scheduled long-term chemotherapy, bilateral middle meningeal artery (MMA) embolization was performed to prevent recurrence of subdural hemorrhage. Although pancytopenia occurred during the 7 months' follow-up period, residual chronic subdural hemorrhage was absorbed without recurrence. To our best knowledge, this is the first report of CMML with spontaneous chronic SDH. MMA embolization is potentially a useful and safe treatment option in the challenging clinical situations with underlying pathologies.

Keyword

Leukemia; Myelomonocytic; Subdural hematoma; Embolization

MeSH Terms

Aged
Cerebral Hemorrhage
Drug Therapy
Follow-Up Studies
Hematologic Diseases
Hematoma, Subdural*
Hematoma, Subdural, Chronic
Humans
Leukemia
Leukemia, Myelomonocytic, Chronic
Male
Meningeal Arteries
Pancytopenia
Pathology
Recurrence

Figure

• 

  Fig. 1 (A) Unenhanced computed tomography (CT) scan at the time of admission showed left-sided isodensity chronic subdural hematoma. (B) CT scan performed after burr-hole drainage revealed decreased amount of subdural hematoma.

• 

  Fig. 2 (A) Unenhanced computed tomography scan and (B–D) magnetic resonance imaging performed 2 weeks later. Besides newly developed intracerebral hemorrhage in left insular-temporal lobe subcortical white matter with surrounding edema, scanty amount of subdural hematoma was noted in both fronto-temporo-parietal lobes. The signal intensity of left-sided hematoma was consistent with early late acute stage, and that of right-sided hematoma was consistent with subacute stage.

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  Fig. 3 Angiography imaging at pre- and post-embolization of bilateral middle meningeal artery. Rt = right; MMA = middle meningeal artery; Pre = pre-embolization; Post = post-embolization; Lt = left.

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  Fig. 4 Brain computed tomography (CT) performed at (A) 2 weeks, (B) 1 month, (C) 2 months, and (D) 5 months after bilateral middle meningeal artery embolization. Slightly increased subdural hematoma in left side was observed in the 2 months' follow-up CT, but the patient had no headache or neurological complaints correlated with imaging. Pancytopenia with neutropenic fever after the 2nd cycle of decitabin was the only complication. Brain CT performed 5 months later revealed complete resolution of subdural hemorrhage.

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