Endovascular treatment of subdural haematoma in patient under anti-platelet therapy: a case report

• Published in: Annals of medicine and surgery Vol. 86; no. 2; pp. 1066 - 1071
• Main Authors: Thapa, Paras, Bhattarai, Ganesh, Kharel, Santosh Kumar, Kunwar, Pratiksha, Bhandari, Sagar, Bhandari, Shailaj, Shilpakar, Sushil, Thapa, Bikash, Thapa, Ajit, Sharma, Mohan Raj
• Format: Journal Article
• Language: English
• Published: England Lippincott Williams & Wilkins 01.02.2024
• Subjects: Case Reports; anti-platelet therapy; elderly; middle meningeal artery embolization; chronic subdural haematoma (cSDH)
• ISSN: 2049-0801; 2049-0801
• DOI: 10.1097/MS9.0000000000001516

The incidence of chronic subdural haematoma (cSDH) is relatively high among the elderly population. Other known risk factors for cSDH include male sex, dependency on anti-platelet or anticoagulant medication, and chronic alcoholism. Although, the standard mode of treatment for cSDH is surgery, embolization of the middle meningeal artery (MMA), either upfront or as an adjunct to surgical evacuation can be used for the treatment of cSDH. The authors present a case of a 75-year-old female with prior history of posterior-lateral wall myocardial infarction (MI) eight years back presented to our centre with the chief complaints of a gradual onset of cough and headache for 2 months. The patient had no history of trauma, loss of consciousness, seizures, and vomiting. There was no history of diabetes, hypertension, pulmonary tuberculosis, and other chronic illness. The concurrent use of anti- platelet drug during a surgical procedure can make the treatment challenging. Endovascular treatment can be a primary treatment modality in such situation. Elimination of blood supply by middle meningeal artery embolization is emerging as a safe, minimally invasive alternative to treat cSDH.