Life-threatening intracranial subdural hematoma following spinal surgery: A case report

Introduction: We report a case of a Kernohan notch phenomenon caused by an acute life-threatening intracranial subdural hematoma due to a cerebrospinal fluid (CSF) leak following lumbar surgery.Case report: A 71-year-old patient underwent decompressive lumbar surgery for refractory neurogenic claudication. Intraoperatively, a dural tear was noted and repaired. Two days later, the patient presented a sudden loss of consciousness following a CSF outflow in the subfascial lumbar drain. A head CT revealed an acute intracranial subdural hematoma with mass effect. A craniotomy was performed to evacuate the hematoma. The lumbar operative site was inspected and revealed a CSF leakage due to a dural defect which was subsequently repaired. The patient subsequently developed a Kernohan's notch phenomenon which partially recovered after two months of rehabilitation.Conclusion: We report a rare and dramatic case of Kernohan notch phenomenon due to an acute intracranial subdural hematoma occurring in the setting of a CSF leak following lumbar spine surgery. This case demonstrates the need to be aware of this potentially fatal complication after spine surgery and the importance of early diagnosis and appropriate treatment.