title: [Intracranial hypotension syndrome following manipulation of the cervical spine].
abstract: BACKGROUND
  Chiropractic interventions such as manipulation of the cervical spine can incidentally lead to severe neurological complications.
  
  
  METHODS
  A 63-year-old female patient presented at the Neurology outpatient clinic with a five-week history of severe postural headache, tinnitus and nausea. The onset of these symptoms was concurrent with chiropractic manipulation of the cervical spine because of cervical pain. Cranial MRI showed findings characteristic for intracranial hypotension syndrome. Cervical MRI revealed a large posterior dural tear at the level of Ci-ii. Following unsuccessful conservative therapy, the patient underwent a lumbar epidural blood patch after which she recovered rapidly.
  
  
  CONCLUSIONS
  Manipulation of the cervical spine can cause a dural tear and subsequently an intracranial hypotension syndrome. Postural headaches directly after spinal manipulation should therefore be a reason to suspect this complication. If conservative management fails, an epidural blood patch may be performed.
authors: St. Elisabeth Ziekenhuis, afd. Neurologie, Tilburg.
authors: Gijs H P
authors: GH
authors: Tazelaar
authors: Cees C
authors: CC
authors: Tijssen
mesh_terms: D017217:Blood Patch, Epidural; D002574:Cervical Vertebrae; D005260:Female; D006261:Headache / Q000209:etiology / Q000628:therapy; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D026882:Manipulation, Chiropractic / Q000009:adverse effects*; D020393:Manipulation, Spinal / Q000009:adverse effects; D008875:Middle Aged