Frequency and Diagnostic Utility of Clinical and Radiological Features of Spontaneous Intracranial Hypotension in...

Spontaneous intracranial hypotension (SIH) is an often underrecognized neurological condition resulting from spontaneous cerebrospinal fluid (CSF) leaks. Postpartum women represent a vulnerable population due to unique physiological and procedural factors, yet SIH remains poorly characterized in this group. This study aimed to determine the diagnostic value of clinical and radiological features in identifying SIH among postpartum patients with neurological symptoms.

In a retrospective observational study conducted at Qaem Hospital (Mashhad, Iran), 183 postpartum patients presenting with central nervous system (CNS) symptoms who underwent brain magnetic resonance imaging (MRI) between 2010 and 2023 were evaluated. Demographic, clinical, and gynecologic data were collected. Brain MRI findings were independently reviewed for features indicative of SIH. Comparative analyses were conducted between patients with and without SIH using Fisher's exact test.

SIH was identified in 30 patients (16.4%), making it the third most common diagnosis after normal MRI (46.5%) and posterior reversible encephalopathy syndrome (30.4%). Orthostatic headache (63.3%) and seizure (43.3%) were the most common symptoms among SIH patients. However, no clinical symptom significantly differentiated SIH from non-SIH cases (P>0.05). Specific MRI findings-particularly pachymeningeal enhancement (P<0.001), dural venous sinus distension (P<0.001), pituitary enlargement (P=0.01), and brain sagging (P=0.004)-were significantly more frequent in SIH patients.

SIH is a noteworthy cause of postpartum neurological symptoms. Given the limited specificity of clinical features, contrast-enhanced brain MRI plays a crucial role in diagnosis. Clinicians should maintain a high index of suspicion for SIH in postpartum patients presenting with CNS symptoms.