PURPOSE: To evaluate brain MRI findings of spontaneous intracranial hypotension. MATERIALS AND METHODS: A retrospective review of MRI findings was conducted on six patients with clinically proven spontaneous intracranial hypotension ; no patient had history of previous spinal puncture. Follow-up MRI was available in two patients, and to detect CSF leakage, radionuclide cisternography (n=5), myelography (n=1), and MR myelography (n=1) were performed. RESULTS: On contrast-enhanced T1WI, diffuse dural enhancement was seen in all cases, subdural hematoma or hygroma was seen in four cases, pituitary gland prominence in four, dural sinus dilatation in four, downward displacement of cerebellar tonsil in two, downward displacement of iter in one, and suprasellar and prepontine cistern effacement in two. In no patient was abnormal CSF leakage found. CONCLUSION: Although dural enhancement, as seen on MRI, is not specific, diffuse enhancement of dura matter accompanying by subdural hematoma, hygroma, pituitary gland prominence, dural sinus dilatation, downward displacement of the cerebellar tonsil, or suprasellar and prepontine cistern effacement can strongly suggest intracranial hypotension.