title: Postural Headaches Due to Cerebrospinal Fluid Leakage Through Subarachnoid-Pleural Fistula: A Case Report.
abstract: BACKGROUND
  Postural headaches are commonly associated with spontaneous intracranial hypotension and cerebrospinal fluid (CSF) leakage from the spine. A subarachnoid-pleural fistula (SPF) is a very rare and serious type of CSF fistula that has mostly been reported following traumatic causes.
  
  
  METHODS
  Here, the case of a 36-year-old woman who suffered from postural headaches after chiropractic manipulation of her neck was reported. Brain and spinal magnetic resonance (MR) imaging showed brain sagging, a C7-T1 dural defect, and overt CSF leakage. Heavy T2-weighted MR myelography revealed paravertebral fluid collections, communicating with pleural effusions through bilateral SPFs. The postural headaches were relieved by 3 courses of epidural blood patches.
  
  
  CONCLUSIONS
  From the patient's history, her severe SPFs were attributed to rupture of the spinal leptomeninges during vigorous chiropractic manipulation of her neck. Heavy T2-weighted MR myelography could delineate the route of SPFs and CSF leakages.
authors.affiliation: Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Sheng-Feng
authors.initials: SF
authors.lastname: Lin
authors.affiliation: Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Hsing-Yu
authors.initials: HY
authors.lastname: Weng
mesh_terms: D000328:Adult; D065634:Cerebrospinal Fluid Leak / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005402:Fistula / Q000150:complications* / Q000000981:diagnostic imaging; D006261:Headache / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D011187:Posture / Q000502:physiology*
keywords: cerebrospinal fluid leakage; chiropractic manipulation of the neck; postural headache; spontaneous intracranial hypotension; subarachnoid-pleural fistula