Summary of the clinical presentations and imaging findings of spontaneous intracranial hypotension
| Clinical presentations | Imaging findings |
|---|---|
| Headache (core symptom, patterns may vary) Postural headache: worse with upright posture, relieved on lying down Sudden onset severe headache causing emergency presentation New daily persistent headache Exertional headache Associated symptoms Posterior neck pain/stiffness Shoulder stiffness Nausea and vomiting Change in hearing / new tinnitus Unusual clinical presentations Cognitive (frontotemporal) decline Cranial nerve dysfunction Reduced consciousness level | Magnetic resonance imaging of the brain Subdural collections: haematoma or hygroma, often bilateral Prominence/dilatation of the venous sinuses Engorgement of the pituitary gland Downward slumping of the midbrain, flattening of the pons Cerebellar tonsillar descent Medial and inferior migration of the medial temporal lobes Diffuse smooth meningeal thickening and enhancement Normal appearances do not exclude spontaneous intracranial hypotension Magnetic resonance imaging of the spine Epidural fluid collection: often longitudinally extensive Epidural venous distention May be entirely normal |