This easy to use, predictive scoring system is based on the six most relevant brain MRI findings and allows to assess the likelihood of a spinal cerebrospinal fluid (CSF) leak in patients with spontaneous intracranial hypotension (SIH). The scoring system may help headache specialists objectively predict the probability of an underling spinal cerebrspinal fluid leak. It is useful to triage patients who may benefit from more invasive myleographic examinations.
Spontaneous intracranial hypotension
Spontaneous intracranial hypotension (SIH) is an increasingly recognized disorder usually presenting with disabling orthostatic headache, which manifests within minutes after assuming the upright position, and subsides after lying down. According to the common doctrine SIH is triggered by CSF leakage from the intrathecal into the epidural compartment, which is usually due to an osteodiscogenic microspur (calcified disc protrusion or spondylophyte) penetrating the dura, or a leaky spinal nerve root diverticulum. Imaging plays a crucial role in the diagnostic work-up of SIH patients, but many challenges remain, particularly with respect to finding evidence of intracranial hypotension on brain MRI, and identifying and localizing a cerebrospinal fluid (CSF) leak.