RT Journal Article SR Electronic T1 Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension JF Journal of Neurology, Neurosurgery & Psychiatry JO J Neurol Neurosurg Psychiatry FD BMJ Publishing Group Ltd SP 835 OP 843 DO 10.1136/jnnp-2023-331166 VO 94 IS 10 A1 Cheema, Sanjay A1 Anderson, Jane A1 Angus-Leppan, Heather A1 Armstrong, Paul A1 Butteriss, David A1 Carlton Jones, Lalani A1 Choi, David A1 Chotai, Amar A1 D'Antona, Linda A1 Davagnanam, Indran A1 Davies, Brendan A1 Dorman, Paul J A1 Duncan, Callum A1 Ellis, Simon A1 Iodice, Valeria A1 Joy, Clare A1 Lagrata, Susie A1 Mead, Sarah A1 Morland, Danny A1 Nissen, Justin A1 Pople, Jenny A1 Redfern, Nancy A1 Sayal, Parag P A1 Scoffings, Daniel A1 Secker, Russell A1 Toma, Ahmed K A1 Trevarthen, Tamsin A1 Walkden, James A1 Beck, Jürgen A1 Kranz, Peter George A1 Schievink, Wouter A1 Wang, Shuu-Jiun A1 Matharu, Manjit Singh YR 2023 UL http://jnnp.bmj.com/content/94/10/835.abstract AB Background We 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).Methods A 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.Results SIH 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.Conclusions This 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.All data relevant to the study are included in the article or uploaded as supplementary information.