Spontaneous Intracranial Hypotension (SIH)

Specialized MRI for Low Cerebrospinal Fluid Pressure – Identifying the Cause of Headaches

Using specialized MRI scans of the brain and spine, we can detect signs of cerebrospinal fluid (CSF) leakage and specifically investigate the cause.

Our brain and spinal cord are surrounded by a protective fluid known as cerebrospinal fluid (CSF). If this fluid leaks through a hole in the protective membrane surrounding the spinal cord, cerebrospinal fluid hypotension can occur. Specialists refer to this as spontaneous intracranial hypotension (SIH).

Typical symptoms include headaches that worsen when standing or sitting and often improve when lying down. Dizziness, nausea, hearing problems, or neck pain may also occur.

Our Specialized Diagnostic Procedures

  • Brain MRI – Identifying typical changes: Using an MRI scan, typically with contrast dye, we can look for characteristic signs of low cerebrospinal fluid pressure. These include changes in the meninges, dilation of venous blood vessels, enlargement of the pituitary gland, and possible brain herniation.

  • MRI of the entire spine – Searching for cerebrospinal fluid leakage: Using highly sensitive MRI techniques, we can detect fluid accumulations outside the protective spinal cord membrane. These may indicate a leak through which cerebrospinal fluid is escaping.

  • Targeted search for a cerebrospinal fluid leak: Depending on the MRI findings, additional specialized tests may be considered to locate the exact site of the fluid leak. These include, for example, dynamic myelography, in which the leakage of cerebrospinal fluid is visualized using a contrast agent.

  • Identification of specific types of cerebrospinal fluid leakage: Sometimes the cerebrospinal fluid does not flow freely into the surrounding tissue but instead enters a vein directly via an abnormal connection. This so-called cerebrospinal fluid-venous fistula requires specialized diagnostic procedures.

  • Extended MR myelography with intrathecal contrast agent: In select cases, we also perform specialized MRI examinations in which a gadolinium-containing contrast agent is injected directly into the subarachnoid space. This procedure can provide additional clues regarding the location of a cerebrospinal fluid leak. This is an off-label use of the contrast agent, which is performed only after careful individual assessment and detailed informed consent.

Why is it important to pinpoint the exact location of a cerebrospinal fluid leak?

A cerebrospinal fluid leak is a possible cause of persistent headaches—some of which can be severely debilitating—that can often be treated effectively.

The challenge lies in locating the leak as precisely as possible. Not every cerebrospinal fluid leak is visible on a conventional MRI scan. Therefore, additional specialized tests may be necessary.

The more precisely we can determine the cause and location of the cerebrospinal fluid leak, the more precisely we can plan further treatment—for example, through a special blood patch or, if necessary, surgical intervention.

Close Interdisciplinary Collaboration

Diagnosis is carried out in close collaboration between neuroradiology, neurology, and other specialized disciplines.

At our low cerebrospinal fluid pressure clinic , we jointly evaluate the patient’s symptoms, previous test results, and possible next diagnostic and therapeutic steps.

Our goal: To identify the cause of low cerebrospinal fluid pressure as accurately as possible, to locate even hard-to-detect cerebrospinal fluid leaks, and thereby enable targeted and highly effective treatment.

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