Presentation
Headache for past 3 weeks.
Patient Data
Bilateral fronto-parieto-temporo-occipital acute-on-subacute subdural hemorrhage (SDH); maximal thickness of 14 mm on right, and 8 mm on left. Diffuse sulcal effacement on the right and partial on the left. Subtle subfalcine herniation to left. Narrowing of lateral ventricles, right more than left, and of third ventricle.
Right parafalcine and bilateral tentorial SDH, minimal on left.
She underwent bilateral middle meningeal artery embolization.
Follow-up CT done ~20 days after the first.
Highly attenuating bilateral meningeal arteries, status post-embolization.
Bilateral mild reduction in subdural hematoma (SDH) thickness, with expected hematoma evolution (i.e. no acute component).
Partial resolution of subfalcine herniation and bilateral sulcal effacement.
Parafalcine SDH resorbed, left tentorial SDH all but resorbed, right tentorial SDH less dense.
Case Discussion
This case demonstrates the appearance meningeal arteries post-embolization with polyvinyl alcohol (PVA) particles. Intra-arterial embolization is used either instead of surgery (craniotomy, burr holes) or as an adjunct treatment for chronic subdural hemorrhage (cSDH), as with surgery alone, there is rebleed in up to ~30% of cases 1-3.
The embolization material appears hyperdense to cortical bone. Hence, it casts artifacts similarly to highly attenuating intravenous contrast material.
Unable to process the form. Check for errors and try again.