Abstract
BackgroundAdverse intracranial events after spinal surgery were related with intracranial hypotension due to surgical injury of dura mater.Case presentationA 72-year-old woman received posterior lumbar interbody fusion under general anesthesia. Immediately after the patient was transitioned to the supine position and muscular relaxants were reversed, she developed generalized seizure. The seizure was immediately suppressed with propofol. Brain computed tomography was unremarkable. Although she returned to the surgical suite, an evident point of dural laceration was not found. The dura was covered with fibrin glue. Magnetic resonance imaging revealed subarachnoid hemorrhage (SAH) on postoperative day 1. By postoperative day 2, the seizure had resolved. The cause of her seizure was suspected to be SAH due to intracranial hypotension. Seizure was masked by ongoing anesthesia and muscle relaxation.ConclusionsAlthough spinal surgeries are common procedure, we must carefully consider its related potentially life-threatening adverse events.
Highlights
Adverse intracranial events after spinal surgery were related with intracranial hypotension due to surgical injury of dura mater.Case presentation: A 72-year-old woman received posterior lumbar interbody fusion under general anesthesia
We report a case of seizure during emergence from general anesthesia
There was minimal output from the drainage tube, our surgical team suspected cauda equina incarceration or the other unknown cause of seizure in the surgical field, because they knew that any neurologic manifestation could appear by intracranial hypotension after spinal surgeries [5, 6]
Summary
It is important for anesthesiologists to carefully understand the surgical procedure and its related potentially life-threatening adverse intracranial events even in common cases, whenever encountering unforeseen events in the perioperative period. All authors read and approved the final manuscript. Consent for publication Written informed consent was obtained from the patient for publication of this case report and accompanying images. Competing interests The authors declare that they have no competing interests. Author details 1Department of Anesthesia, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai 591-8025, Japan. Author details 1Department of Anesthesia, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai 591-8025, Japan. 2Department of Anesthesia, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan. 3Department of Anesthesiology, Osaka City University Medical School, 1-5-7 Asahi-machi, Abeno-ku, Osaka 545-8586, Japan
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