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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(01): 128-138
DOI: 10.1055/s-0043-1774301
Review Article

Spontaneous Intracranial Hypotension: A Review of Neuroimaging and Current Concepts

Sharath Kumar Goddu Govindappa 
1   Department of Radiology, Apollo Hospitals, Sheshadripuram, Bangalore, Karnataka, India
,
Chaitra Parameshwara Adiga 
1   Department of Radiology, Apollo Hospitals, Sheshadripuram, Bangalore, Karnataka, India
,
Savith Kumar 
1   Department of Radiology, Apollo Hospitals, Sheshadripuram, Bangalore, Karnataka, India
,
Lakshmikanth N. Goolahally
1   Department of Radiology, Apollo Hospitals, Sheshadripuram, Bangalore, Karnataka, India
,
Sujit Kumar
2   Department of Neurology, Apollo Hospitals, Sheshadripuram, Bangalore, Karnataka, India
› Author Affiliations Funding None.
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Abstract

Spontaneous intracranial hypotension (SICH) is the emerging cause of orthostatic headache as it has been better recognized in recent years. SICH happens due to spinal cerebrospinal fluid (CSF) leak; however, the manifestations are predominantly cranial and hence imaging in SICH includes brain and spine. There are few characteristic brain imaging features to be concerned about to diagnose SICH in patients with vague symptoms or low clinical suspicion. Spine screening is recommended in these patients to assess spinal CSF leaks. While neuroradiologists play a significant role from the time of diagnosis to treatment of SICH, there is a need for all the general radiologists to be aware of the condition. Computed tomography myelogram and digital subtraction myelogram are performed for diagnostic and therapeutic management of SICH. There is a known risk for SICH recurrence in patients with sagittal longitudinal epidural collection and hence, targeted blood patch should be used instead of blind patch. Most importantly, slow mobilization is recommended following the patch to avoid recurrence.

Keywords

spontaneous intracranial hypotension - CT myelography - orthostatic headache

Learning Points

1. Headache with postural nature is an important symptom.


2. Imaging in SICH should include both brain and spine.


3. Negative imaging does not rule out SICH. High index of suspicion is necessary as it can mimic many conditions, ranging from Arnold Chiari I to amyotrophic lateral sclerosis.


4. Dynamic myelogram is preferred over conventional myelogram.


5. Multimodality treatment is available at present.




Publication History

Article published online:
16 September 2023

© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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