Acupuncture is widely used in Asian countries. A 27-year-old man visited our center with a newly developed orthostatic headache. A few weeks previously, he had undergone multiple and repetitive acupunctures at the low back (L3-S1) to relieve pain, which remained after laminectomy and interbody fusion (L4-S1) for the last few years. CSF drops were observed from the skin at the left low back (figure 1). Brain MRI was normal. CSF leakage with fistula formation was confirmed by magnetic resonance myelography (figure 2).1 Duroplasty (L4-5) with primary suture of the fistula was performed and the headache improved.
Figure 1. CSF drops at low back.
CSF, as water drops, was observed from the left lumbar skin, most prominently in the morning and at the left lateral decubitus position.
Figure 2. Fistula formation and CSF leakage confirmed on imaging.
CSF leakage (left L3-4-5 area; arrow) and abnormal fluid collection (along the left paraspinal muscle; arrowhead) was observed (A). A fistula formation (arrow) between neural foramen and abnormal fluid collection was observed at the laminectomy site (A, B, magnetic resonance myelography; C, T2-weighted image).
Appendix. Authors
Footnotes
Teaching slides links.lww.com/WNL/A827
Study funding
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (no. 2017R1C1B5017843).
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Reference
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