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Intracranial hypotension following chiropractic spinal manipulation
Sashank Prasad1, Ghassan El-Haddad, Hongming Zhuang
1Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Chiropractic manipulation can cause intracranial hypotension due to cerebrospinal fluid leaks. Radionuclide cisternography precisely located a lumbar dural tear after cervical manipulation, aiding treatment decisions.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Intracranial hypotension is a condition characterized by low cerebrospinal fluid pressure.
- Cerebrospinal fluid leaks are a common cause of spontaneous intracranial hypotension.
- Chiropractic manipulation has been anecdotally linked to cerebrospinal fluid leaks.
Observation:
- A patient developed intracranial hypotension following chiropractic spinal manipulation.
- The cerebrospinal fluid leak was identified as a lumbar dural tear.
- This dural tear was remote from the site of manipulation.
Findings:
- Radionuclide cisternography successfully localized the cerebrospinal fluid leak to the lumbar dura.
- Spinal magnetic resonance imaging provided a falsely localized site of the dural tear.
- This case highlights a discrepancy between imaging modalities in pinpointing the leak.
Implications:
- Accurate localization of cerebrospinal fluid leaks is crucial for effective treatment, especially for invasive therapies.
- Radionuclide cisternography offers a valuable tool for precise leak localization in cases of intracranial hypotension post-manipulation.
- Clinicians should consider chiropractic manipulation as a potential cause of intracranial hypotension and be aware of imaging limitations.
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