# A Case Report of Rare Coagulation Factor Abnormalities (Factors VII, XI, and XII) in a Patient With Chronic Subdural Hematoma and Treatment With Middle Meningeal Artery Embolization

## TL;DR

This case report describes a rare coagulation disorder involving factors VII, XI, and XII in a patient with chronic subdural hematoma, successfully treated with middle meningeal artery embolization.

## Contribution

The paper presents the first reported case of acquired coagulopathy involving factors VII, XI, and XII, and demonstrates the effectiveness of MMA embolization in such a scenario.

## Key findings

- The patient exhibited prolonged activated partial thromboplastin time and reduced activities of coagulation factors VII, XI, and XII.
- MMA embolization using N-butyl cyanoacrylate effectively prevented hematoma recurrence and relieved symptoms.
- The case highlights a novel treatment approach for CSDH in patients with limited coagulation disorder treatment options.

## Abstract

Acquired coagulopathy is uncommon. Cases of hemophilia A, which is characterized by reduced coagulation factor Ⅷ, have been reported but cases involving diminished factors VII, Ⅺ, or XII have not been reported. We report the case of a patient who presented with a chronic subdural hematoma (CSDH), which was challenging to treat due to underlying acquired coagulation abnormalities. Middle meningeal artery (MMA) embolization is a promising approach for managing refractory CSDH and has proved effective in this case.

An 82-year-old man with no significant medical history and family history presented with a headache and discomfort in his right lower extremity. A left CSDH was detected. Subsequent tests revealed prolonged activated partial thromboplastin time and decreased activities of coagulation factors VII, Ⅺ, and XII. Emergency burr-hole irrigation was performed after administering recombinant coagulation factor VIIa. Two months later, the patient developed aphasia and recurrent hematoma. MMA embolization using N-butyl cyanoacrylate was performed to avoid recurrence, and burr-hole drainage reduced brain compression. The symptoms were relieved, and no recurrence was reported after discharge.

This case description highlights a rare case of CSDH caused by the decreased activities of factors VII, XI, and XII. In addition, the efficacy of MMA embolization in patients with CSDH and limited coagulation disorder treatment options was demonstrated.