Journal of Neurology, Neurosurgery & PsychiatryMultidisciplinary Consensus Guideline for the Diagnosis and Management of Spontaneous Intracranial Hypotension

A 29-member specialist interest group (SIG) was formed, comprising representation from neurology, neuroradiology, anesthesia, neurosurgery, and patient advocacy. The SIG unanimously agreed on the scope and purpose of the guideline. Using a modified Delphi method, the SIG then created guideline statements for a number of question themes. A rigorous literature study, surveys of patients and healthcare professionals, and a review by numerous international experts on SIH all contributed to this process.

Any patient presenting with orthostatic headache should be evaluated for spontaneous intracranial hypotension (SIH) and its possible diagnosis. MRI of the brain with contrast and the whole spine should be used as first-line imaging. The non-targeted epidural blood patch (EBP) is the first-line treatment and should be performed as soon as possible. The authors discuss treatment ideas and present criteria for doing myelography based on the spine MRI result and response to EBP. There are also recommendations for conservative care, symptomatic headache treatment, and management of SIH consequences.