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Intracranial hypotension after chiropractic manipulation of the cervical spine
  1. J Beck1,
  2. A Raabe1,
  3. V Seifert1,
  4. E Dettmann2
  1. 1Department of Neurosurgery Johann Wolfgang Goethe-University, Frankfurt am Main 60528, Germany
  2. 2Department of Neuroradiology, Johann Wolfgang Goethe-University
  1. Correspondence to:
 Dr Jürgen Beck; 

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The aetiology of intracranial hypotension is not fully understood, but CSF leakage from spinal meningeal diverticula or dural tears may be involved. In the majority of patients without a history of mechanical opening of the dura the cause of intracranial hypotension is unknown and the syndrome is termed “spontaneous” intracranial hypotension. We report a case of intracranial hypotension ensuing after a spinal chiropractic manipulation leading to CSF isodense effusion in the upper cervical spine.

Case report

A 40 year old woman undertook a spinal chiropractic manipulation. The chiropractioner grasped the head of the supine patient and exerted axial tension while rotating the head. During this manoeuvre the patient complained of a sudden sharp pain in her upper neck, and the procedure had to be stopped immediately. Subsequently she complained of headaches and after 24 hours she developed nausea and vomiting. Her headaches worsened, and lying down gave the only measure of limited relief. On the sixth day she developed double vision and presented to the neurology department of a community hospital.

She had a right abducens palsy and pachymeningeal gadolinium enhancement on magnetic resonance imaging (MRI). …

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