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A 77-year-old male with a past medical history of posterior lumbar interbody fusion(L4/5) presented with a 6 months history of lower back and left leg (lateral thigh) pain. Preoperative MRI imaging revealed left neural foraminal stenosis at L4-5 with spondylolisthesis. On the first visit, a transforaminal epidural block was performed at the L4/5 level using a mixture of 0.4% lidocaine 5ml with dexamethasone 2.5mg, hyaluronidase 5cc. On the second visit, an L4/5 interlaminar epidural block was performed in order to improve the flow of the injectate. 15 minutes after the injection, the patient complained of persistent numbness in both legs with motor function intact. Blood pressure and heart rate dropped slightly, but soon recovered without any treatment given. The patient’s speech became slurred after 40 minutes, then his behavior became violent and aggressive. After about 60-80 minutes, his behavior was not controlled. We consulted a neurologist, who gave an opinion that despite having no obvious neurological abnormalities, the violent behavior might have been caused by lidocaine CNS toxicity. The neurologist suggested a MRI diffusion of the brain to be done to rule out any acute lesions. 2mg of midazolam was administered to control the violent behavior prior to the MRI diffusion. No abnormalities were found on the MRI, and the patient returned home after regaining consciousness.