TY - JOUR T1 - Intracranial hypotension after chiropractic manipulation of the cervical spine JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry SP - 821 LP - 822 DO - 10.1136/jnnp.74.6.821 VL - 74 IS - 6 AU - J Beck AU - A Raabe AU - V Seifert AU - E Dettmann Y1 - 2003/06/01 UR - http://jnnp.bmj.com/content/74/6/821.abstract N2 - 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. 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). … ER -