This clever mneumonic helps physicians to remember the findings on cranial (brain) MRI imaging in intracranial hypotension (low CSF volume and pressure in the head) from spinal CSF (cerebrospinal fluid) leaks.

ALL patients with suspected intracranial hypotension should have cranial (brain) MRI with contrast to look for these findings and for additional complications.
Patients with intracranial hypotension may have all of these findings, one or more findings, or none.

S = subdural fluid collections – may be small to large fluid collections or subdural hematomas
E = enhancement of meninges (layers around brain more obvious with contrast than normal)
E = engorgement of venous structures (veins swollen)
P = pituitary hyperemia (pituitary looks swollen)
S = sagging of brain – including, but not limited to cerebellar tonsillar herniation into spinal canal (acquired Chiari)

It is important to note that the absence of these findings does NOT rule out intracranial hypotension.

Reference: Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006 May 17;295(19):2286-96.
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