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Intracranial hypotension and abducens palsy following upper spinal manipulation
  1. K Kurbanyan1,
  2. S Lessell2
  1. 1
    David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
  2. 2
    Neuro-Ophthalmology Unit, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
  1. K Kurbanyan, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA; kkurbanyan{at}gmail.com

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Intracranial hypotension with its characteristic orthostatic headache, a not infrequent complication of lumbar puncture, may also occur spontaneously. Evidence is accumulating that cervical manipulation can be a precipitating factor.16 When there are ophthalmic symptoms and signs, the patient may present to an ophthalmologist.7 Here we report an example of cervical manipulation-induced intracranial hypotension with ophthalmoplegia. A 46-year-old woman developed orthostatic headache and a unilateral abducens palsy within days of upper cervical manipulation by a chiropractor. Magnetic resonance imaging (MRI) showed meningeal enhancement after gadolinium administration, which was initially interpreted to represent an infiltrative process. However, lumbar puncture documented a low opening pressure and a high cerebrospinal fluid (CSF) protein content. The patient …

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