Diagnostic yield of Bern spontaneous intracerebral hypotension score by myelogram and brain MRI


  • Lateral decubitus digital subtraction myelogram (LDDSM) shows a high diagnostic yield for pinpointing the exact location of spinal cerebrospinal fluid (CSF) leak in patients, which increases with higher Bern spontaneous intracerebral hypotension (SIH) score.

Why this matters

  • A number of imaging modalities such as LDDSM are used to aid diagnosis of SIH (due to CSF leak from thecal sac or along nerve root sleeve); however, data on this specific technique is limited due to the relative rarity of SIH and consequent lack of institutions utilizing it.

  • Association of higher SIH scores with greater likelihood of LDDSM-identified leaks may direct clinical practice by reducing the need for invasive procedures, potentially enhancing patient quality of life and emotional outcomes, as well as adherence to clinical treatment plans.