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Updated: Jul 19, 2026

Automated Midline Shift and Intracranial Pressure Estimation based on Brain CT Images
Published on: April 13, 2013
Spontaneous intracranial hypotension: correlation of imaging findings with clinical features
Elke Wiesemann1, Georg Berding, Friedrich Goetz
1Department of Neurology, Medical School Hannover, Hannover, Germany.
Background:
Spontaneous intracranial hypotension (SIH) is increasingly recognized as a clinically variable and likely underdiagnosed syndrome caused by non-traumatic CSF leaks. The aim of this study was to correlate the findings of imaging studies - magnetic resonance imaging (MRI), radionuclide cisternography - with clinical features and CSF pressure in SIH in order to improve the diagnostic yield and management in patients with SIH.
Methods:
Clinical case study of 10 consecutive cases of SIH, MRI, radio-isotope cisternography.
Results:
5 out of 10 patients had unusual clinical symptoms of SIH(2 subdural haematomas, 1 gait ataxia, 1 tinnitus, 1 haemodialysis-associated headache). In 7 patients pachymeningeal gadolinium enhancement was detected in MRI accompanied by a reduced CSF opening pressure. In contrast, the 3 patients with normal MRI also had a normal CSF pressure. Radio-isotope cisternography was abnormal in all patients tested. There was no correlation between the severity of clinical symptoms and MRI or radionuclide cisternography findings.
Conclusions:
The spectrum of clinical symptoms and imaging findings in SIH is highly variable. There- fore the diagnosis of SIH is often delayed. Radio-isotope cisternography is an important additional diagnostic method to detect CSF leaks or pathological kinetics of radio-isotope movement particularly in cases with normal MRI findings.
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