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How often is a contrast-enhanced brain MRI truly normal in the setting of spontaneous intracranial hypotension?

I am aware that the radiological signs can be subtle or overlooked, or confused with a Chiari malformation, hence, I will typically review images with a fellowship-trained neuroradiologist when the clinical suspicion is high. I have read that contrast brain MRI is ~80% sensitive, so I will sometimes order heavily T2-weighted spine imaging as well and/or refer to a subspecialist, but I am not sure if this is necessary.
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Neurology · UPMC
Answered on

In a paper by D'Antona et al., PMID 33393980:

"Of 6878 articles, 144 met the selection criteria and reported on average 53 patients with SIH each (range, 10-568 patients). The most common symptoms were orthostatic headache (92% [95% CI, 87%-96%]), nausea (54% [95% CI, 46%-62%]), and neck pain/stiffne...

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