Tonic-clonic seizures as a possible complication for cerebrospinal fluid leakage after intradural spinal surgery, a case report

Background: Cerebrospinal fluid leakage is a well-known spinal surgery complication, especially in adults population. Pseudomeningocele is its most common manifestation and it can bring to some conditions, such as intracranial hypotension, infections and wound healing complication. Epilepsy is not classically associated to CSF leakage. We described a case of a female patient who developed tonic-clonic seizures associated with a pseudomeningocele after a detethering surgery. Case description: A 16 year old female was admitted to our department for surgical treatment of a tethered cord for a sacral lipoma. Her medical history was remarkable mental retardation with psychiatric disturbs and hypothyroidism. She underwent a surgical intervention for the detethering of conus and dura was closed by a suture and fibrin glue. During third postoperative day she started to suffer a severe occipital headache, followed by tonic-clonic seizures. During suture removal, a collection suspected for a pseudomeningocele was found and chemical and radiological exams confirmed the dubious. Despite a continuous bed rest, collection continued to form. So, we decided to perform a surgical revision and to close dural defect. After intervention, patient did not suffer postural headache anymore and after 3 and 6 months she was found in good health. Conclusion: We described the importance of significant morbidity, i.e. that of tonic clonic seizures as a sign of an occult CSF leakage after spinal surgery. Here, hydrocephalus as a condition was present, the change in pressure of CSF can determine seizures as well as promote this complication. A pseudomeningocele is not a trivial complication.