Potential value of radionuclide cisternography in diagnosis and management planning of spontaneous intracranial hypotension

Objectives: Spontaneous intracranial hypotension (SIH) is caused by spontaneous spinal cerebrospinal fluid (CSF) leaks. However, there is debate regarding clinical indication of radionuclide cisternography (RNC) for identification of the actual site of a CSF leak. We therefore investigated the potential value of RNC in SIH. Patients and methods: RNC was performed on 30 patients with SIH. Patients were managed with conservative management only or epidural blood patches (EBPs) according to clinical conditions and RNC findings. Results: RNC revealed direct signs of spinal CSF leaks in 80% of patients. Of this group, complete resolution of headache was obtained in 12 (71%) of 17 patients who received EBP vs. 1 (14%) of 7 patients treated with conservative management only (p = 0.02). Complete headache relief with conservative management only was seen in one (14%) patient with direct signs of spinal CSF leaks compared to five (83%) patients without direct signs (p = 0.03). Conclusion: RNC is useful for diagnosis and better management planning of SIH.