{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:46:24Z","timestamp":1789670784139,"version":"4.0.1"},"reference-count":65,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T00:00:00Z","timestamp":1683244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Spontaneous intracranial hypotension (SIH) occurs due to a leakage of the cerebrospinal fluid (CSF) lowering the pressure of subarachnoid space, mostly caused by a dural breach or discogenic microspur. As a result of less support provided by CSF pressure, intracranial structures are stretched downward, leading to a constellation of more or less typical MRI findings, including venous congestion, subdural effusions, brainstem sagging and low-lying cerebellar tonsils. Clinic examination and an MRI are usually enough to allow for the diagnosis; however, finding the location of the dural tear is challenging. SIH shares some MRI features with Chiari malformation type I (CM1), especially low-lying cerebellar tonsils. Since SIH is likely underdiagnosed, these findings could be interpreted as signs of CM1, leading to a misdiagnosis and an incorrect treatment pathway. Medical treatment, including steroids, bed rest, hydration caffeine, and a blind epidural blood patch, have been used in this condition with variable success rates. For some years, CSF venous fistulas have been described as the cause of SIH, and a specific diagnostic and therapeutic pathway have been proposed. The current literature on SIH with a focus on diagnosis, treatment, and differential diagnosis with CM1, is reviewed and discussed.<\/jats:p>","DOI":"10.3390\/jcm12093287","type":"journal-article","created":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T02:56:51Z","timestamp":1683255411000},"page":"3287","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Overview of Spontaneous Intracranial Hypotension and Differential Diagnosis with Chiari I Malformation"],"prefix":"10.3390","volume":"12","author":[{"given":"Wan Muhammad Nazief","family":"Bin Wan Hassan","sequence":"first","affiliation":[{"name":"Radiology Department, Interventional Radiology Unit, Kuala Lumpur General Hospital, Kuala Lumpur 50586, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5674-0575","authenticated-orcid":false,"given":"Francesco","family":"Mistretta","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7352-3107","authenticated-orcid":false,"given":"Stefano","family":"Molinaro","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Bosco","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Stroke Unit, University of Turin, Azienda Ospedaliera Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Gambino","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Radiology Unit, University of Turin, Azienda Ospedaliera Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Bergui","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/S0140-6736(53)91948-5","article-title":"Normal and pathological physiology of the cerebrospinal fluid circulation","volume":"261","author":"Schaltenbrand","year":"1953","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s10194-007-0421-8","article-title":"Frequency of spontaneous intracranial hypotension in the emergency department","volume":"8","author":"Schievink","year":"2007","journal-title":"J. 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