{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T13:18:25Z","timestamp":1779110305566,"version":"3.51.4"},"reference-count":35,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T00:00:00Z","timestamp":1778976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Intracranial hypotension is a rare and underdiagnosed serious condition characterized by low cerebrospinal fluid (CSF) pressure, often resulting from trauma to the dura mater. While manual therapy is increasingly used for musculoskeletal complaints, it is not without risk and may, in rare cases, result in complications such as dural tears. Although these complications are rare, they require early recognition and appropriate treatment to prevent further morbidity. This case report aims to highlight a rare presentation of multilevel dural defects in temporal association with manual therapy and to demonstrate the efficacy of epidural blood patch (EBP) treatment. Case Presentation: We report a case of a 46-year-old woman without chronic illness who developed worsening orthostatic headaches, weakness, and vomiting after multiple manual therapy sessions. Only after 6 months did the patient undergo magnetic resonance imaging (MRI), which revealed intracranial hypotension due to dural damage in the spinal dura mater at C6\u2013T1 and T8\u2013T10, brain sagging, and an increased risk of subdural hematoma. After excluding other causes of dural defects, EBP was performed under CT guidance at C6\u2013C7 and T8\u2013T9, which resulted in symptom regression. Follow-up MRI was recommended for the patient. Conclusions: This case highlights a rare but clinically significant occurrence of multilevel dural defects and intracranial hypotension in temporal association with manual therapy. This emphasizes the critical role of timely diagnosis using MRI and the clinical effectiveness of EBP as a minimally invasive procedure.<\/jats:p>","DOI":"10.3390\/jcm15103860","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:36:40Z","timestamp":1779107800000},"page":"3860","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Manual Therapy-Associated Dural Tear Causing Intracranial Hypotension Treated with an Epidural Blood Patch: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"given":"Niklavs","family":"Nemme","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Clinical Simulations, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7457-1901","authenticated-orcid":false,"given":"Arturs","family":"Balodis","sequence":"additional","affiliation":[{"name":"Department of Radiology, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Institute of Diagnostic Radiology, Paula Stradins Clinical University Hospital, LV-1002 Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1533-5746","authenticated-orcid":false,"given":"Mara","family":"Klibus","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Clinical Simulations, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Department of Anaesthesiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olegs","family":"Sabelnikovs","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Clinical Simulations, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Department of Anaesthesiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arina","family":"Novasa","sequence":"additional","affiliation":[{"name":"Department of Neurology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5111-9484","authenticated-orcid":false,"given":"Jolanta","family":"Osina","sequence":"additional","affiliation":[{"name":"Department of Neurology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"},{"name":"Residency in Algology, Faculty of Residency, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Sarkele","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Clinical Simulations, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Department of Anaesthesiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.nic.2010.07.012","article-title":"Intracranial Hypotension and Intracranial Hypertension","volume":"20","author":"Yuh","year":"2010","journal-title":"Neuroimaging Clin. 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