PMC8247675_01
(a) MRI brain T1 axial demonstrating bilateral hypodense fluid collections (chronic subdural hematoma [cSDH]), (b) CT head noncontrasted axial demonstrating acute on chronic right SDH, (c) CT head coronal reconstruction demonstrating subtle nondisplaced skull fracture.
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F1
An 18-month-old with a history of nonaccidental trauma (NAT) originally presented at 5 months of age with an acute right parietal skull fracture and bilateral SDH treated with burr hole drainage [Figure 1].
(a) MRI brain T2 axial and (b) coronal demonstrating resolution of the left subdural hematoma (SDH) with chronic SDH on the right with well-organized membrane compressing the underlying cortex.
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F2
Repeat imaging revealed that his right-sided cSDH had formed a membrane and some small hemorrhage concerning for potential new NAT [Figure 2].
(a) CT head with contrast axial and (b) coronal demonstrating improvement of the subdural hematoma (SDH) in the area of the craniotomy but there remained chronic SDH with membranes at the periphery of the craniotomy's reach.
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F3
Follow-up imaging 6 weeks later revealed resolution of the right-sided SDH in the area of the craniotomy but there remained cSDH with membranes at the periphery of the craniotomy's reach [Figure 3].
(a) AP and (b) lateral angiographic view of selective microcatheter injection of the right middle meningeal artery late phase demonstrated blush of the chronic subdural hematoma membrane at the convexity.
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F4
The right MMA was selectively catheterized [Figure 4] and after confirming no orbital collateral anastomoses, we proceeded with embolization using Onyx embolisate material (Medtronic, Irvine, CA).
CT head without contrast coronal views (a and b) 6 months after the right middle meningeal artery embolization demonstrating nearly resolved right chronic subdural hematoma.
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F5
Follow-up CTs were performed at 2 weeks, 3 months, and 6 months postprocedure [Figure 5].