Spontaneous intracranial hypotension with negative brain MRI findings: a systematic review of diagnostic strategies and clinical outcomes - Report - MDSpire

Spontaneous intracranial hypotension with negative brain MRI findings: a systematic review of diagnostic strategies and clinical outcomes

  • By

  • Marina Romozzi

  • Giuseppe Garignano

  • Valid Rastegar

  • Francesco Onorati

  • Catello Vollono

  • Federico Tosto

  • Masahito Katsuki

  • Yasuhiko Matsumori

  • Francesco Signorelli

  • July 9, 2026

  • 0 min

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Clinical Report: Systematic Review of Diagnostic Approaches in SIH

Overview

This systematic review examines spontaneous intracranial hypotension (SIH) cases with normal brain MRI findings, highlighting the diagnostic challenges and advanced imaging techniques that can identify occult cerebrospinal fluid leaks.

Background

Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache and is typically associated with specific brain MRI findings. However, some patients present with normal MRI results, complicating diagnosis and management. Understanding the clinical features and advanced diagnostic strategies for MRI-negative SIH is crucial.

Data Highlights

No numerical data available in the source material.

Key Findings

  • Brain MRI-negative SIH occurs in a substantial minority of patients.
  • Advanced imaging techniques such as CT myelography, MR myelography, and digital subtraction myelography can help identify occult CSF leaks.
  • Absence of typical brain MRI findings should not exclude the diagnosis of SIH in patients with suggestive clinical presentations.

Clinical Implications

Clinicians should consider advanced imaging modalities for patients with suspected SIH who have normal brain MRI findings.

Conclusion

The systematic review emphasizes the importance of further diagnostic evaluation in patients with suspected SIH despite normal brain MRI findings.

Related Resources & Content

  1. Frontiers | Spontaneous intracranial hypotension with negative brain MRI findings: a systematic review of diagnostic strategies and clinical outcomes
  2. Assessment of Flow Dynamics: A Meta-Analysis of Phase-Contrast MRI Research in Idiopathic Normal Pressure Hydrocephalus
  3. Dynamics of Cerebrospinal Fluid in Idiopathic Intracranial Hypertension: A Review of Current Literature and Validation of Recent Research Findings
  4. the ophthalmologist — Decoding Idiopathic Intracranial Hypertension
  5. Critical Care (Springer) — Diagnostic accuracy of transcranial Doppler for cerebral vasospasm in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis
  6. Current guideline framework on Imaging of Suspected Intracranial Hypotension
  7. Frontiers | Spontaneous intracranial hypotension with negative brain MRI findings: a systematic review of diagnostic strategies and clinical outcomes
  8. Direct comparison of digital subtraction myelography versus CT myelography in lateral decubitus position: evaluation of diagnostic yield for cerebrospinal fluid-venous fistulas - PubMed

Original Source(s)

Spontaneous intracranial hypotension with negative brain MRI findings: a systematic review of diagnostic strategies and clinical outcomes

  • by Marina Romozzi, Giuseppe Garignano, Valid Rastegar, Francesco Onorati, Catello Vollono, Federico Tosto, Masahito Katsuki, Yasuhiko Matsumori, Francesco Signorelli

  • July 9, 2026

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