Seizures After Lumbar Laminectomy: A Clinical Case

Incidental durotomy can occur as a complication of spine surgery, potentially resulting in serious intracranial complications. We report a case of a 71-year-old female with significant spinal stenosis from L3-L5 who underwent a posterior lumbar decompression and fusion. In the immediate post-operative period, she developed generalized tonic-clonic seizures. A brain computed tomography scan was urgently performed, showing a slight decrease in the amplitude of the supratentorial ventricular system, associated with engorgement of the venous sinuses, interpeduncular hyperdensity, and thalamic hypodensities (evoking a pseudohypoxic pattern). These changes, taken together, were consistent with the suspicion of cerebrospinal fluid (CSF) hypotension. A brain magnetic resonance image was done, confirming a pseudohypoxic cerebral pattern. This case illustrates CSF hypotension after iatrogenic dural tear, manifested by generalized seizures. Repairing an incidental durotomy should be done as early as possible to reduce CSF leakage and prevent the devastating effects of CSF hypotension.