Radiographic Evaluation of Spontaneous Intracranial Hypotension

Diagnostic imaging evaluation for patients with suspected spontaneous intracranial hypotension has evolved substantially in recent years. This article describes a practical algorithm for radiographic diagnosis of spontaneous intracranial hypotension and localization of spinal CSF leaks.

Brain and spine MRI is the mainstay of the initial diagnostic workup of patients with spontaneous intracranial hypotension. Recently, sophisticated myelographic techniques to precisely subtype and localize CSF leaks have been developed and refined. These include fluoroscopic techniques, such as digital subtraction myelography, and CT-based techniques, such as hyperdynamic CT myelography. These techniques improve the detection of various types of CSF leaks, thereby enabling targeted therapies.

Neurologists should familiarize themselves with the variety of imaging necessary to initially support a diagnosis of spontaneous intracranial hypotension and the myelographic techniques needed to precisely localize spinal CSF leaks.