A case report of seizure during emergence from general anesthesia after lumbar spinal surgery—common cases can develop potentially life-threatening adverse intracranial events

BACKGROUND: 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. 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. CONCLUSIONS: Although spinal surgeries are common procedure, we must carefully consider its related potentially life-threatening adverse events.