1508 - A Rare Case of Middle Cerebral Artery Stroke After Middle Meningeal Artery Embolization

Case Diagnosis: MCA stroke following MMA embolization

Case Description: An active 85 year-old female presented with a right middle cerebral artery embolism. The patient initially presented after a fall and was found to have a subdural hematoma. Ten days later, she underwent right-sided middle meningeal artery embolization for chronic subdural hematoma (cSDH). Three days later, she was noted to exhibit low processing speed and a decline in mobility. Repeat head CT showed a new right frontal lobe infarct, with subsequent MRI of the brain confirming an acute infarct with petechial hemorrhages at the anterior right middle and inferior frontal gyri, corresponding to the MCA superior division territory. Given history, anti-thrombolytics were contraindicated and the patient was discharged to acute inpatient rehabilitation. She participated in physical and occupational therapy with significant improvement.

Discussions: The middle meningeal artery (MMA) supplies blood to the dura mater and additionally feeds capillaries to a cSDH. MMA embolization is a generally well-tolerated treatment for cSDH, aiming to stop arterial blood supply contributing to the subdural space resulting in reaccumulation of cSDH. It has been shown to display a low failure rate, around 2.2%, as compared to a 27.7% failure rate of surgical intervention. Neurological complications are rare following MMA embolization, reported in 1.33% of cases. Of those complications, stroke is exceedingly rare, reported in 0.30-1.0% of cases. Prognosis for stroke following MMA embolization is comparable to other embolic strokes. Factors affecting prognosis include size of the affected territory, comorbidities, age, treatment, and rehabilitation. As such, there are a range of outcomes, including 30-40% of the population with moderate to severe disability, 15-25% mortality in the first few months, and a 10-20% risk of recurrence.

Conclusions: The patient made significant improvement with near-return to baseline through rehabilitation with physical and occupational therapy following a rare complication of middle meningeal artery embolization.