Palliative middle meningeal artery embolisation for symptomatic chronic subdural haematoma in an individual with resistant thrombocytopaenia due to acute myeloid leukaemia

An older male presented with intermittent headaches, reduced mobility and transient facial weakness. CT head scan revealed acute-on-chronic subdural haematoma (cSDH), causing mass effect and midline shift. A background of progressive acute myeloid leukaemia was reported, characterised by severe thrombocytopaenia resistant to haematological therapies. The risk of neurosurgical intervention was deemed to be excessive.Right middle meningeal artery embolisation (MMAE) was pursued to arrest repeated subdural haemorrhage and prevent symptomatic neurological deterioration. The patient was discharged home the following day. Interval CT head showed almost complete resolution of the right cSDH. Symptoms improved and the patient was able to return to living independently at home.MMAE may be an effective intervention in patients with cSDH who are unsuitable candidates for surgery, and where the goal is to maintain functional independence, quality of life and prevent acute neurological decline and disability.