Abstract
Dear Sir I read with interest the letter by Nabih Ramadan. We inadvertently did not reference his article (1) in our article on spontaneous intracranial hypotension (SIH) published in Headache 2004 (2). In fact, we reported Ramadan's article in the references (no 16) of our first work published on SIH in 1995 (3). In any case, the article of Dr Ramadan, also being the first article published on meningeal enhancement in SIH, is incomplete in its reporting of some specific features of SIH. (i) It is not specified that meningeal enhancement includes only the dura mater and not all meninges. This is very important in the differential diagnosis with other disorders (especially with meningeal carcinomatosis). (ii) It is not specified at what level the epidural autologous blood patches were performed and what its volume was (was it a large volume?). In fact, in SIH it is necessary to perform a large-volume autologous blood patch.