A Case of Acute Contrast Induced Neurotoxicity Simulating Stroke After Middle Meningeal Artery Embolization: Insights from Literature

Introduction: Middle meningeal artery (MMA) embolization is becoming an important treatment option for chronic subdural hematoma (CSDH), particularly for patients who are at a higher risk of recurrence or are not candidates for surgery. This technique is associated with lower rates of complications and recurrences when compared to traditional surgical methods. Contrast-induced neurotoxicity (CIN) is a rare complication of endovascular procedures, and its underlying mechanisms remain poorly understood. Case Presentation: An 82-year-old female presented to the emergency department (ED) with a worsening headache, two months after a fall. A non contrast computed tomography (NCCT) scan revealed a mixed-age left-sided subdural hematoma measuring approximately 1.7 cm, causing mass effect on the sulci of the left cerebral hemisphere. The patient was admitted for observation with a diagnosis of acute on chronic subdural hematoma and scheduled for left middle meningeal artery embolization. The procedure was successful; however, the patient developed neurological deficits one hour post-procedure, with a National Institutes of Health Stroke Scale (NIHSS) score of 16. Urgent NCCT, CT angiography (CTA) of the head and neck, and Magnetic resonance imaging (MRI) of the brain showed no acute findings or evidence of large vessel occlusion, high-grade stenosis, or ischemia. The patient’s symptoms resolved within 24 hours, and she returned to baseline the following day. Contrast-induced neurotoxicity was diagnosed as the cause of her symptoms.