Persistent PSMA Expression at a Subdural Hematoma Following Middle Meningeal Artery Embolization

An 82-year-old man on active surveillance for low-risk prostate cancer underwent 18 F-DCFPyL PET/CT PET/CT for rising PSA. Imaging revealed interval progression of known intraprostatic malignancy. Interestingly, intracranial uptake was seen along the right frontoparietal convexity, corresponding to a known chronic subdural hematoma (cSDH) in this patient who had previously undergone middle meningeal artery embolization. This case highlights prostate-specific membrane antigen (PSMA) expression associated with cSDH, likely reflecting inflammation-driven neoangiogenesis. Recognition of such uptake is essential to avoid misinterpretation as metastatic disease and may provide novel insights into cSDH pathophysiology and potential therapeutic targets.