title: Intracranial hypotension induced by cervical spine chiropractic manipulation.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  We report a case of intracranial hypotension ensuing after a spinal chiropractic manipulation leading to cerebrospinal fluid (CSF) isodense effusion in the upper cervical and thoracic spine.
  
  
  BACKGROUND
  The etiology of intracranial hypotension is not fully understood, but CSF leakage from spinal meningeal diverticula or dural tears may be involved.
  
  
  METHODS
  A 36-year-old woman presented with neck and both shoulder pain 4 days earlier. She undertook a spinal chiropractic manipulation. After this maneuver, she complained of a throbbing headache with nausea and vomiting. Her headache worsened, and lying down gave the only measure of limited relief. In CSF study, it showed dry tapping. Brain MRI showed pachymeningeal gadolinum enhancement. Thoracic spine MRI showed CSF leakage. After admission to the hospital, she was treated by hydration and pain control over several days. However, her headache did not improve.
  
  
  RESULTS
  She was treated by epidural blood patch. Afterwards, her headache was improved. This is the first case of spontaneous intracranial hypotension in which spinal chiropractic manipulation coincided with the development of symptoms and in which a CSF collection in the upper cervical and thoracic spine was demonstrated radiographically in Korea.
  
  
  CONCLUSIONS
  From this case, we can understand the etiology of intracranial hypotension and consider the complication of chiropractic manipulation.
authors.affiliation: Department of Diagnostic Radiology, Korea University, School of Medicine, Seoul, Korea.
authors.forename: Sang-Il
authors.initials: SI
authors.lastname: Suh
authors.forename: Seong-Beom
authors.initials: SB
authors.lastname: Koh
authors.forename: Eun-Jung
authors.initials: EJ
authors.lastname: Choi
authors.forename: Byung-Jo
authors.initials: BJ
authors.lastname: Kim
authors.forename: Min-Kyu
authors.initials: MK
authors.lastname: Park
authors.forename: Kun-Woo
authors.initials: KW
authors.lastname: Park
authors.forename: Joon-Shik
authors.initials: JS
authors.lastname: Yoon
authors.forename: Dae-Hie
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural; D001921:Brain / Q000473:pathology; D002555:Cerebrospinal Fluid; D002574:Cervical Vertebrae; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D019585:Intracranial Hypotension / Q000209:etiology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D026882:Manipulation, Chiropractic / Q000009:adverse effects*; D026301:Manipulation, Osteopathic / Q000009:adverse effects*; D019838:Neck Injuries / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome