Neurovisual Findings in the Syndrome of Spontaneous Intracranial Hypotension from Dural Cerebrospinal Fluid Leak

Spontaneous Intracranial Hypotension (SIH) is produced by leakage of cerebrospinal fluid (CSF) from a spinal meningeal defect. The cardinal feature of the syndrome is headache, relieved by assuming a recumbent posture. Patients also report neck stiffness, nausea, vomiting, vertigo, and tinnitus. MR scans in patients with SIH have shown a remarkable constellation of findings: diffuse thickening and gadolinium enhancement oft he meninges, descent of the brainstem, flattening of the basis pontis, and effacement of the cortical sulci.