Abstract
A 67-year-old man exhibited systemic convulsions and persistent disturbance of consciousness immediately after the operation of posterior inter-body fusion for the lumbar vertebrae L4-L5. Pseudohypoxic brain swelling (PHBS) was cited as a possible cause of these symptoms because the image change unique to hypoxic encephalopathy was found at the head CT and MRI, in spite of observing neither obvious hypoxemia nor lasting low blood pressure during the operation, and a large volume of extradural drainage existed after the operation. The level of consciousness was improved by removing the extradural drain and treating with some conservative treatment such as horizontal position. Eventually, he was discharged from the hospital without having neurological deficit. The pathophysiology of PHBS is considered to be a cerebral venous perfusion disorder due to a sudden loss of cerebrospinal fluid caused by a cerebrospinal fluid leak or negative pressure drainage management after spinal surgery. It is crucial to understand the risk and the pathophysiology of PHBS as a complication after spinal surgery.
