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Spontaneous intracranial hypotension (SIH) is a leading identifiable cause of a new daily persistent headache, typically either orthostatic or developing in the latter half of the day. Many other symptoms may be present, and the marked variability in phenotype between patients often leads to a delay in diagnosis. For many patients, initial diagnostic imaging includes spinal imaging with highly T2-weighted MRI or magnetic resonance (MR) myelography based on early small case series suggesting that spinal MRI correlated well with findings on conventional CT myelogram.1,2 However, even in the most sophisticated and experienced centers, the rate of finding a leak on spinal MRI among patients clinically suspected of having a CSF leak is relatively low when prospectively collected and evaluated.3
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