Learning objectives: Upon completion of this presentation, participants will be able to: 1) Recognize the MRI appearance of the spontaneous intracranial Hypotension. 2) Review its various clinical and imaging presentations.Presentation summary: CSF leak is a recognized cause of intracranial Hypotension. This condition may be spontaneous or secondary to spinal puncture, neurosurgical procedures (iatrogenic), dehydration, uremia and spinal trauma. The principal symptom of spontaneous CSF leaks is orthostatic or postural (positional) headache which occurs when the patient is in an upright position, and gradually disappears when the patient is lying down. In most cases, the headaches gradually increase from the moment the patient wakes up in the morning. However, in other cases the headaches are quick and severe. The acuteness of the headaches varies in each case, which affects how quickly the condition is diagnosed. Some of the other related symptoms of SIH are hearing loss, dizziness, tinnitus, vertigo, and stiffness of the neck, nausea, loss of consciousness, coma and vomiting. In neurological examinations cranial nerve palsies (mainly VI) may be found. In neuroimaging studies, especially on MR imaging, several nonspecific presentations such as dural enhancement, vertical displacement of the brain, subdural effusion or subdural hematomas mainly in chronic cases and an appearance like Arnold-Chiari type I malformation may be seen. Conclusion: In this presentation we will review 3 patients with spontaneous intracranial Hypotension. As mentioned there are heterogeneous groups of signs and symptoms and MRI presentations in this disorder which may cause misdiagnosis with other neurological disorders. Therefore, awareness, understanding, and recognition of these presentations may permit the radiologist and neurologist to play a significant role in the prevention of unwanted surgical interventions or extensive diagnostic evaluation procedures.