RT Journal Article SR Electronic T1 Treatment of spontaneous intracranial hypotension: experiences in a UK regional neurosciences Centre JF Clinical Medicine JO Clin Med FD Royal College of Physicians SP e247 OP e251 DO 10.7861/clinmed.2020-0791 VO 21 IS 3 A1 Joanna E Perthen A1 Paul J Dorman A1 Danny Morland A1 Nancy Redfern A1 David JA Butteriss YR 2021 UL http://www.rcpjournals.org/content/21/3/e247.abstract AB A robust treatment paradigm for spontaneous intracranial hypotension has yet to be agreed upon. We present retrospective data from the patient cohort at our UK regional neurosciences centre from 2010–2020 and describe our locally developed treatment pathway.Seventy-three patients were identified: 31 men and 42 women; mean age was 42 years. The majority presented with a headache of variable duration, and most had positive imaging. Very few patients (7%) responded to conservative treatment. Sixty-six underwent epidural blood patching, with 39 (59%) having a good response. Twenty-three patients underwent myelography and targeted treatment (injection of fibrin sealant at the leak site), with 13 (57%) showing a good response. One patient had successful surgery. The relapse rate after response to epidural blood patching was 10%, and after response to targeted treatment was 23%. Most patients who relapsed responded to repeated treatments.The outcome data for our diverse patient cohort shows the success of a staged approach to treatment. Relapse rates are low, and surgery is only rarely required. We use these data to inform our discussions with patients, and present them here to enable other centres to develop robust investigation and treatment paradigms of their own.