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German neurologists report the case of a 40-year-old woman who had a chiropractic upper spinal manipulation and immediately afterwards suffered increasingly severe symptoms of intracranial hypotension, e.g. headache, nausea and vomiting. After considerable diagnostic confusion a dural tear was found at the level of C1-C2. There were no other causes for the leak of cerebro-spinal fluid. The authors are thus certain that this is the first well-documented case of intracranial hypotension caused by chiropractic. They also speculate that a substantial amount of cases of 'spontaneous' intracranial hypotension may be related to upper spinal manipulation. Journal of Neurology, Neurosurgery and Psychiatry (2003)