Background: Euglycemic diabetic ketoacidosis (EDKA) is a rare but serious complication linked to sodium-glucose cotransporter 2 inhibitor use. Cases of EDKA are increasingly being diagnosed during the perioperative period; however, owing to normal glucose levels, the condition is often overlooked or misattributed to other causes, such as surgical complications—particularly in patients undergoing neurosurgery.Case Report: We present a case of a man in his seventies with poorly controlled diabetes and recent empagliflozin use who developed EDKA following a craniectomy for drainage of an intracranial abscess, with postoperative symptoms mimicking those of an intracranial process. Despite mildly elevated glucose levels, a basic metabolic panel revealed high anion gap metabolic acidosis. Insulin and dextrose therapy was initiated, and the condition resolved within 24 hours. Conclusion This case underscores the need for early recognition of EDKA, especially in neurosurgical settings, where many neurological symptoms of ketoacidosis can be misattributed to postoperative complications.