Spontaneous intracranial hypotension (SIH) is a severe neurological disease where cerebrospinal fluid (CSF) leakage in the spine causes orthostatic headache, cognitive dysfunction, tinnitus, mental dullness, diplopia and, in worst cases, coma.  Yet, if correctly diagnosed, it is a fully treatable disease. If the clinical suspicion of SIH is lacking, a multitude of scans, misdiagnoses and fatal diagnostic delays are the result. The estimated annual incidence rate is at least 5 per 100,000 in the general population, close to other serious neurological disorders such as subarachnoid hemorrhage. Several epidemiological and pathophysiological aspects of SIH are currently unexplored. 

The CCLEAR7T is a collaboration between DRCMR and Danish Headache Center to use ultra-high field MRI in combination with a newly developed MRI sequence, CSF-STREAM, to measure CSF circulation as well as structural alterations in fine CSF pathways around the brain. We aim to gain new and unique knowledge on how the brain and CSF regulation are altered when SIH causes a decrease in intracranial pressure and how and whether these alterations are reversed upon following successful treatment. Due to its mechanical nature and simple reversibility, SIH is a unique condition to study CSF dynamics and their influence on brain waste clearance pathways safely in humans. The results will also serve as input for developing a state-of-the-art diagnostic evaluation of SIH.