Cerebrospinal fluid leak secondary to chiropractic manipulation
This 29-year-old Asian female, who was otherwise in previously good health, presented with recurrent episodes of severe headache, nausea, and vomiting. She described the headache as “pulling” downward, triggered by standing, and resolving when supine. She reported having had axial tension and rotatory manipulation of her neck one week prior to the onset of her symptoms but denied immediate symptoms afterward. She experienced increasingly painful headaches over the 2 weeks following her chiropractic manipulation. She had no known prior history of trauma, dural structural pathology, or connective tissue disease.\nPhysical exam was normal with no neurological deficits. Previous cervical magnetic resonance imaging (MRI) with and without contrast had been unremarkable. Cervical MRI at presentation revealed only a CSF-isodense ventral extradural fluid collection in the lower cervical spine and upper thoracic spine without any mass effect on the thecal sac []. There was no meningeal enhancement, perineural cyst, dural ectasia, or abnormal venous engorgement.\nThe patient was managed conservatively with bed rest for 2 weeks and made a complete spontaneous recovery. Follow-up cervical MRI at 6 months demonstrated decreased size of ventral extradural fluid collection []. The patient is doing well presently (1 year subsequent to chiropractic procedure).