Spontaneous Intracranial Hypotension: Imaging in Diagnosis and Treatment

Radiol Clin North Am. 2019 Mar;57(2):439-451. doi: 10.1016/j.rcl.2018.10.004. Epub 2018 Dec 7.


This article reviews the role of imaging in the diagnosis, management, and treatment of spontaneous intracranial hypotension (SIH). SIH is a debilitating and often misdiagnosed condition caused by either a spinal cerebrospinal fluid (CSF) leak or a CSF to venous fistula. This pathologic condition is identified and localized via spinal imaging, including computed tomographic (CT) myelography, dynamic myelography, dynamic (ultrafast) CT myelography, MR imaging, or MR myelography with intrathecal gadolinium. Treatment of SIH involves conservative measures, surgery, or imaging-guided epidural blood patching.

Keywords: CSF Leak; CSF to venous fistula; Epidural blood patch; Myelogram; Spontaneous intracranial hypotension.

Publication types

  • Review

MeSH terms

  • Humans
  • Intracranial Hypotension / diagnostic imaging*
  • Magnetic Resonance Imaging / methods*
  • Myelography / methods*
  • Tomography, X-Ray Computed / methods*