Pneumocephalus (PNC) is an unusual but critical complication of epidural procedures and spine surgery only a few cases have been reported in the literature. 1,2 It is an abnormal presence of air in the cranium and usually caused by traumatic head injuries, infectious gas-forming bacteria, brain tumors, cranial surgeries, spontaneous autogenic factors, otorhinolaryngology procedures and diagnostic interventions such as lumbar puncture. 3 Magnetic resonance imaging can be definitive in the diagnosis but is less sensitive than computed tomography (CT) scans. CT imaging is the gold standard imaging technique for the diagnosis of PNC. 2 In this text; we present and discuss a case of PNC who presented to the emergency department (ED) with headache and change in mental status following lumbar disc surgery. CASE REPORTA 67-year-old female patient with worsening headache and change in mental status was presented to the ED. In her medical history, it has been learned that she had undergone lumbar disc surgery for L1-5 herniation four days. Her history was positive for epilepsy, hypertension, and deep vein thrombosis, and she was using phenytoin. At the time of admission, vital signs of the patient were normal except for 130 beats heart rate tachycardia. She was drowsy, nonoriented and non-cooperative. The Glaskow Coma Score was 12 (E3M5V4). Muscle strength and deep tendon reflexes were normal and bilaterally symmetrical. The rest of the physical examination was normal. Electrolytes, complete blood count, arterial blood gases, liver and kidney function tests, and cardiac markers were normal. Non-contrast brain-CT revealed PNC in the fronto-temporal fossa (Figure 1). There was no midline shift or mass effect. Also, pneumatization in the supraorbital region was also attracted attention. The patient was given antiemetics and analgesics and admitted. The patient was transferred to the neurosurgery intensive care unit for clinical observation.