MRI Findings of Intracranial Hypotension Syndrome


ICHD-2 Criteria for Diagnosis of Intracranial Hypotension:

  1. orthostatic headache (starts 15 minutes to hours after upright positioning, improves 15-30 minutes after lying down)
  2. PLUS at least 1 of the following:
    1. neck stiffness, tinnitus, hyperacusia, photophobia,  nausea
    2. CSF opening pressure <6cm H20, observation of CSF leakage on imaging, MR imaging features of IHS


Classic Imaging Findings in IHS:

  1. diffuse dural enhancement, 85%
  2. brain descent on sagittal, 40-50%
  3. Caudal displacement of tonsils, 25-75%
  4. bilateral subdural fluid collections, 15%




Other MRI findings:

  • thickening and enhancement of dura
  • pituitary enlargement
  • subdural effusion (hematocele)
  • venous engorgement

Intracranial hypotension MRI findings


Brain MRI (below). (a) Diffuse dural thickening, (b) herniation of the cerebellar amygdalae, (c) bilateral fronto-temporal subdural collections, (d) diffuse cerebral edema.



Quantitative Indicators: In patients with IHS, the pontomesencephalic angle and mamillo-pointine distance may help in diagnosing this syndrome more accurately.

  • mamillopontine distance
    • inferior margin of mammillary bodies to superior margin of pons
    • 6.4mm (Sn and Sp of 73.1%)
  • pontomesencephalic angle
    • angle between a line drawn along the anterior margin of the midbrain and the anterosuperior margin of the pons
    • 51.7 deg (Sn 76.9% and Sp 96.2%)




Other MRI Findings:






Anvekar, Dr. “Neuroradiology Cases: Intracranial Hypotension MRI”. N.p., 2011. Web. 14 Jan. 2016.

Quintero, Iván Fernando et al. “Intracranial Hypotension Syndrome: A Post Dural Puncture Headache?”. Colombian Journal of Anesthesiology 41.1 (2013): 57-60. Web. 14 Jan. 2016.,. N.p., 2016. Web. 14 Jan. 2016.


Tian, Weizhong et al. “A Quantitative Study Of Intracranial Hypotensive Syndrome By Magnetic Resonance”. Clinical Neurology and Neurosurgery 141 (2016): 71-76. Web. 14 Jan. 2016.


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