Dobrocky T, et al. - In this first-in-kind case-control study, researchers investigated if a simple predictive score based on brain MRI findings could reliably detect a spinal cerebrospinal fluid (CSF) leak in patients with spontaneous intracranial hypotension (SIH). They developed a brain MRI–based imaging predictive modeling score to assess the likelihood of a CSF leak in patients with suspected SIH. A total of 152 consecutive patients who were investigated for SIH at a single hospital department from February 2013 to October 2017, were studied to develop a simple scoring system integrating 6 relevant brain imaging findings. Using this 9-point scoring system, headache specialists could objectively identify the patients with SIH who may require further investigation with invasive tests that use intrathecal contrast media to identify a spinal CSF leak that might be resolved with an epidural blood patch or microsurgical exploration. This score could be easily applied in routine clinical care and could lead to more standardized diagnostic and therapeutic pathways.