• Swathi Chidambaram, Kevin Swong, Michael Ander, and Russel P Nockels.
• Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
• World Neurosurg. 2020 Jan 1; 133: 155-158.

BackgroundPseudohypoxic brain swelling (PHBS), also known as postoperative intracranial hypotension-associated venous congestion, is a rare complication after neurosurgery characterized by rapid and often severe postoperative deterioration in consciousness and distinct imaging findings on brain magnetic resonance imaging. Imaging findings associated with PHBS include computed tomography and magnetic resonance imaging findings that resemble hypoxic changes and intracranial hypotensive changes in basal ganglia and thalamus, telencephalic, and infratentorial regions without notable changes in intracranial vasculature.Case DescriptionThis report describes the case of an L4-5 microdiskectomy with posterior decompression and fusion complicated by clinical and radiographic findings resembling PHBS without a known intraoperative durotomy.ConclusionsSpine surgeons should be alerted to the possibility that PHBS may occur in patients even after an operation without known durotomy or cerebrospinal fluid leakage and with spontaneous clinical resolution unrelated to suction drainage changes or epidural blood patches.Copyright © 2019 Elsevier Inc. All rights reserved.

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