General neurologyOriginal researchOPEN ACCESSMultidisciplinary consensus guideline for thediagnosis and management of spontaneousintracranial hypotensionSanjay Cheema,2 Jane Anderson,3 Heather Angus-Leppan Paul Armstrong,David ButterissLalani Carlton Jones,.David Choi Amar ChotaiLinda D'Antona Indran Davagnanam,1 Brendan Davies,1 Paul J Dorman,12Callum Duncan,Simon Elis,Valeria lodice,4 Clare Joy,Susie Lagrata,Sarah Mead,5 Danny Morland,1 Justin Nissen,7 Jenny Pople,5 Nancy Redfern,Parag P Sayal Daniel Scoffings,Russell Secker,5 Ahmed K Toma,19Tamsin Trevarthen,5 James Walkden,Jrgen Beck,2 Peter George Kranz,21Wouter Schievink,2 Shuu-Jiun Wang,23.24 Manjit Singh Matharu2Additional supplementalABSTRACTmaterial is published onlineBackground We aimed to ceate a multidisciplinaryWHAT IS ALREADY KNOWN ON THIS TOPIConly.To view,please visitconsensus clinical quideline for best practice in theThere is currently a lack of consistency andthe journal online (http://dx.doi.org/10.1136/jnnp-2023-diagnosis,investigation and management of spontaneousestablished treatment pathways for the331166.intracranial hypotension(SIH)due to cerebrospinal fluidinvestigation and management of patients withleak based on current evidence and consensus from asuspected spontaneous intracranial hypotensionFor numbered affiliations seeend of article.multidisciplinary spedalist interest group(SIG)(SIH)due to cerebrospinal fluid(CSF)leak,andMethods A 29-member SIG was established,withmost of the published literature on SIH is frommembers from neurology,neuroradiology,anaesthetics,single centres with a dedicated service forCorrespondence toDr Manjit Singh Matharu,UCLneurosurgery and patient representatives.The scopepatients with CSF leak and may be biased byQueen Square Institute ofand purpose of the guideline were agreed by the SIG bylocal factors.Neurology,London WC1N 3BG.consensus.The SIG then developed guideline statements forUK;manjit.matharu@uclac.ukWHAT THIS STUDY ADDSa series of question topics using a modified Delphi process.This process was supported by a systematic literatureTo the best of our knowledge this is the firstReceived 27 January 2023Accepted 21 April 2023review,surveys of patients and healthcare professionalsmultidisciplinary consensus-based guideline forand review by several international experts on SIH.SIH.It covers all aspects of the patient pathwayResults SIH and its differential diagnoses should befrom point of first presentation with suspectedconsidered in any patient presenting with orthostaticSIH to follow-up after treatment.headache.First-line imaging should be MRI of the brainHOW THIS STUDY MIGHT AFFECT RESEARCH,with contrast and the whole spine.First-line treatment isPRACTICE OR POLICYnon-targeted epidural blood patch(EBP),which shouldThis will directly influence clinical practice,be performed as early as possible.We provide criteria forproduce greater consistency in care,improveperforming myelography depending on the spine MRIdiagnostic accuracy,pro
