• Sanjay Cheema, Jane Anderson, Heather Angus-Leppan, Paul Armstrong, David Butteriss, Lalani Carlton Jones, David Choi, Amar Chotai, Linda D'Antona, Indran Davagnanam, Brendan Davies, Paul J Dorman, Callum Duncan, Simon Ellis, Valeria Iodice, Clare Joy, Susie Lagrata, Sarah Mead, Danny Morland, Justin Nissen, Jenny Pople, Nancy Redfern, Parag P Sayal, Daniel Scoffings, Russell Secker, Ahmed K Toma, Tamsin Trevarthen, James Walkden, Jürgen Beck, Peter George Kranz, Wouter Schievink, Shuu-Jiun Wang, and Manjit Singh Matharu.
• Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
• J. Neurol. Neurosurg. Psychiatr. 2023 Oct 1; 94 (10): 835843835-843.

BackgroundWe aimed to create a multidisciplinary consensus clinical guideline for best practice in the diagnosis, investigation and management of spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid leak based on current evidence and consensus from a multidisciplinary specialist interest group (SIG).MethodsA 29-member SIG was established, with members from neurology, neuroradiology, anaesthetics, neurosurgery and patient representatives. The scope and purpose of the guideline were agreed by the SIG by consensus. The SIG then developed guideline statements for a series of question topics using a modified Delphi process. This process was supported by a systematic literature review, surveys of patients and healthcare professionals and review by several international experts on SIH.ResultsSIH and its differential diagnoses should be considered in any patient presenting with orthostatic headache. First-line imaging should be MRI of the brain with contrast and the whole spine. First-line treatment is non-targeted epidural blood patch (EBP), which should be performed as early as possible. We provide criteria for performing myelography depending on the spine MRI result and response to EBP, and we outline principles of treatments. Recommendations for conservative management, symptomatic treatment of headache and management of complications of SIH are also provided.ConclusionsThis multidisciplinary consensus clinical guideline has the potential to increase awareness of SIH among healthcare professionals, produce greater consistency in care, improve diagnostic accuracy, promote effective investigations and treatments and reduce disability attributable to SIH.© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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