Pseudohypoxic brain swelling, also known as postoperative intracranial hypotension-associated venous congestion, is an intriguing complication following routine neurosurgical interventions. We report a case of a 73-year-old female patient who exhibited this rare complication following an elective L4-L5 laminectomy, without evidence of intraoperative cerebrospinal fluid leakage. Initially presenting with clinical features suggestive of anoxic/hypoxic brain injury, the case deviated from typical pseudohypoxic ischemic venous hypertension (PIHV) patterns, leading to a challenging diagnostic process.
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