Pseudohypoxic brain swelling following elective lumbar laminectomy: A rare case report and review of literature.

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. The patient's remarkable recovery, contrary to the initial grim prognosis, emphasizes the critical need for considering PIHV in differential diagnoses when postoperative symptoms mimic anoxic/hypoxic brain injuries. This case contributes to the evolving understanding of PIHV, particularly in scenarios lacking conventional risk factors like cerebral spinal fluid (CSF) leakage, and underscores the importance of comprehensive postoperative surveillance and management. It also highlights the imperative for continued research into the pathophysiology and treatment strategies of PIHV to enhance patient outcomes in complex surgical contexts.