Teaching NeuroImages: Cerebrospinal fluid leakage observed from skin after acupuncture

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.

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