Intracerebral hemorrhage is a rare complication of spinal anesthesia. We report a case in a 83-year-old man with a history of Alzheimer dementia who underwent vesicolitholapaxy with spinal anesthesia and midazolam sedation. Until 1 hour after the end of anesthesia and operation he did not regain his consciousness. Immediate computerized tomogram of brain revealed a left frontal intracerebral hemorrhage. An emergency craniectomy was performed to remove the hematoma. Patients with prolonged recovery of consciousness after spinal anesthesia with midazolam sedation require neurologic and radiologic monitoring to rule out the possibility of intracranial complications.