Intracranial hypotension caused by dural-pleural fistula.

This report describes a rare complication in a woman who underwent thoracic spinal surgery. One month postoperatively, her rehabilitation was interrupted by the development of a severe headache, nausea, vomiting, and a right-side occulomotor nerve palsy. Imaging of her brain revealed changes typical of intracranial hypotension, and subsequent imaging of the spine revealed a cerebrospinal fluid (CSF) leak at the site of surgery. The CSF was seen to track into the right pleural space via a dural-pleural fistula. Surgical repair of the fistula led to a definitive resolution in symptoms, thus highlighting the importance of early recognition of this highly unusual complication.