LAUSR

OBJECTIVE Spontaneous Intracranial Hypotension (SIH) remains a diagnostic and therapeutic challenge. Non-specific clinical features and a reluctance to treat without confirmatory imaging evidence undermine management. Investigations are often insensitive, expensive with many patients continuing to an Epidural Blood Patch (EBP) despite negative results. Current diagnostic standards are based upon a literature base skewed towards difficult to treat cases at specialty centers. This study aims to develop a robust diagnostic and treatment algorithm in real-life clinical practice by 1) investigating the prognostic utility of symptoms of SIH and results of associated investigation from which a scoring system is derived and 2) analysing the role of EBP as a diagnostic and treatment tool. METHODS This is a retrospective study of 86 patients fulfilling clinical criteria for SIH and undergoing EBP, with follow up ranging from 1 month to 15 years, using patient medical records and an online questionnaire. RESULTS Although specific and prognostically significant, MRI Brain (MRI B), MRI Spine (MRI S) and symptom based scoring systems were too insensitive to be of practical use. Most patients with positive and sustained responses to EBP did not meet current criteria for diagnosis. The 72-hour response to the first EBP was found to be highly specific and sensitive in the diagnosis of SIH in our cohort. CONCLUSIONS This study supports the utility of EBP as a safe, accessible and accurate diagnostic and therapeutic tool. We propose a simple treatment algorithm which facilitates diagnosis, treatment and prediction of long term outcomes in this challenging condition.