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Correspondence
Dural tear and intracranial hypotension in a chiropractic patient
  1. J O Di Duro
  1. Private Chiropractic Practice, Vicenza, Italy, and Postgraduate and Continuing Education Department Faculty, New York Chiropractic College, Seneca Falls, NY, USA
  1. Correspondence to:
 Dr J O Di Duro
 Via Prati 14, 36100 Vicenza, Italy; jdiduroprotec.it

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    The report of Dr Beck et al that a spinal chiropractic manipulation may lead to intracranial hypotension opens a debate between internal/genetic forces versus external/epigenetic events in the aetiology of dural tears.1 Considering that only 20% of patients with basilar fractures resulting in a dural tear experience CSF leakage,2 one could question how an external force from a physiological movement of the neck, which when delivered by hand generates only a minute fraction of the forces needed to fracture a bone, could tear a “healthy” dura. However, internal weakness of the dura has been …

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