# Recommendations for the diagnosis and treatment of spontaneous intracranial hypotension

**Authors:** Elisa Francesca Maria Ciceri, Luigi Cirillo, Francesco Causin, Ferdinando Caranci, Alessandra Splendiani, Mario Muto, Mauro Bergui

PMC · DOI: 10.1007/s11547-025-02116-6 · La Radiologia Medica · 2025-10-30

## TL;DR

This paper provides a practical guide for diagnosing and treating spontaneous intracranial hypotension, a condition causing disabling headaches due to cerebrospinal fluid leaks.

## Contribution

The paper introduces a systematic, individualized approach to managing spontaneous intracranial hypotension in different clinical scenarios.

## Key findings

- SIH mainly affects working-age women and is likely underdiagnosed.
- A step-by-step model is proposed to confirm diagnosis and guide treatment.
- The approach aims to improve clinical decision-making for better patient outcomes.

## Abstract

Spontaneous intracranial hypotension (SIH) is a syndrome characterized by disabling orthostatic headache, resulting from a reduction in volume of cerebrospinal fluid (CSF) likely caused by a CSF leak. It mainly affects women at working age and is probably underdiagnosed. This protocol aims to present a proposal for a practical approach to the diagnosis and treatment of SIH. After a descriptive section of the clinical manifestations of SIH, we present a step-by-step model of action to confirm its diagnosis and treatment, considering different clinical scenarios. The aim is, therefore, to facilitate clinical decision-making through a systematized and individualized approach, aiming to best interest of the patient.

## Linked entities

- **Diseases:** spontaneous intracranial hypotension (MONDO:0018624)

## Full-text entities

- **Diseases:** SIH (MESH:D019585), CSF leak (MESH:D065634), orthostatic headache (MESH:D006261)
- **Species:** Homo sapiens (human, species) [taxon 9606]

## Full text

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## Figures

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Source: https://tomesphere.com/paper/PMC12932351