- Incidental durotomy can occur as a complication of spine surgery, which may potentially result in serious intracranial complications. We report a case of a 72 years old male with significant cervical spinal stenosis from C3 to C5 with spinal cord myelomalacia who underwent a posterior cervical decompression with instrumentation and fusion from C3-C5. An incidental dural tear was encountered during the surgery, with a sudden gush of cerebrospinal fluid (CSF) managed intraoperatively. Unfortunately, he developed generalized tonic-clonic seizures subsequently in the immediate post-operative period. Computerized tomography (CT) scan was urgently done which revealed intracranial pneumocephalus, subarachnoid hemorrhage and a right acute subdural hematoma. This case illustrates the intracranial hemorrhage potential subsequent to iatrogenic dural tear and CSF leak manifested by generalized seizures. The repair of incidental durotomy should be done immediately to decrease the amount of CSF leak and prevent any devastating effects of intracranial hemorrhage. The mechanism of this type of bleeding, risk factors and appropriate management are discussed, along with a review of the literature.