Spontaneous intracranial hypotension (SIH) is an often debilitating medical condition resulting from the disturbance of a well-regulated equilibrium within the CSF compartment. The trigger for continuous CSF loss is usually an osteodiscogenic microspur (calcified disc protrusion or spondylophyte) penetrating the dura, or a leaking nerve root sleeve diverticulum.
Various signs may be observed on brain magnetic resonance imaging (MRI) in SIH patients. Recently we proposed the brain spontaneous intracranial hypotension score (bSIH) score integrating 6 imaging findings; 3 major (2 points each) – pachymeningeal enhancement, engorgement of venous sinus, and effacement of the suprasellar cistern (≤4.0 mm), and 3 minor (1 point each) – subdural fluid collection, effacement of the prepontine cistern (≤5.0 mm), and mamillopontine distance (≤6.5 mm) (Fig. 1). The score ranges from 0 to 9, and patients with a score of <2, 3–4, or >5 have a low, intermediate, or high probability of a spinal CSF loss.
We have developed a free smartphone app to facilitate the calculation of the bSIH score. The link is provided above.
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