Postural Headaches Due to Cerebrospinal Fluid Leakage Through Subarachnoid-Pleural Fistula: A Case Report

Sheng Feng Lin, Hsing Yu Weng

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

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. Case Report: 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. Discussions: 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.

Original languageEnglish
Pages (from-to)467-471
Number of pages5
JournalHeadache
Volume57
Issue number3
DOIs
Publication statusPublished - Mar 1 2017

Keywords

  • cerebrospinal fluid leakage
  • chiropractic manipulation of the neck
  • postural headache
  • spontaneous intracranial hypotension
  • subarachnoid-pleural fistula

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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