title: Nightmare complication after lumbar disc surgery: cranial nontraumatic acute epidural hematoma.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  The nontraumatic cranial epidural hematoma is an extremely rare clinical entity and it commonly occurs in the presence of infectious diseases as complication of sinusitis, coagulopathy, vascular malformation of the dura, hemorrhagic tumor, in patients with sickle cell disease, systemic lupus erythematosus, after open heart surgery, and in patients on hemodialysis.
  
  
  BACKGROUND
  We reported a case of spontaneous epidural hematoma that occurred after herniated disc surgery. There was no history of preceding head trauma and patient medical history was unremarkable. To date, no report is found of cranial epidural hematoma after lumbar discectomy.
  
  
  METHODS
  A 58-year-old woman was operated because of a herniated disc at lumbar L3-L4 level and spinal stenosis. Bilateral L3-L4 interlaminectomies and L3-L4 discectomy were performed. Hemovac drain was placed in epidural space. Four hours after surgery, the patient developed left side weakness accompanied with nausea, vomiting, and severe headache. Urgent computed tomography of the head showed acute cranial epidural hematoma and the patient underwent emergent surgery. There was no evidence of trauma of the scalp or any other anatomical abnormality. Control computed tomography 14 hours after evacuation of the hematoma showed new extradural hematoma at the site of the previous one. Patient underwent second surgery.
  
  
  RESULTS
  Nine days after operation of the spine, patient recovered completely with no neurological deficit, but the cerebrospinal fluid showed at the place of spinal wound. Patient was operated once more and a minor dural tear was revealed, which was repaired. The patient was discharged on ninth postoperative and she recovered completely.
  
  
  CONCLUSIONS
  There have been described rare cases of spontaneous subdural, intracerebral, and intracerebellar hematoma caused by intracranial hypotension, but this is the first described case of spontaneous cranial epidural hematoma after lumbar disc surgery caused by intracranial hypotension.
authors.affiliation: Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia. ggrahov@mef.hr
authors.forename: Gordan
authors.initials: G
authors.lastname: Grahovac
authors.forename: Milorad
authors.initials: M
authors.lastname: Vilendecic
authors.forename: Darko
authors.initials: D
authors.lastname: Chudy
authors.forename: Dubravka
authors.initials: D
authors.lastname: Srdoc
authors.forename: Jasenka
authors.initials: J
authors.lastname: Skrlin
mesh_terms: D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D013130:Spinal Stenosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome