The Bern score, also known as the brain spontaneous intracranial hypotension (bSIH) score, is a predictive score derived from brain MRI findings in patients with suspected spontaneous intracranial hypotension. It stratifies patients into high, intermediate or low probability of finding a spinal CSF leak/CSF-venous fistula at myelography 1,2,4.
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Usage
The Bern score helps select patients for additional investigations, such as digital subtraction myelography or CT myelography, to identify a CSF leak or CSF-venous fistula. This is important as these investigations are invasive, time-consuming, and potentially high radiation doses 4. It should be noted, however, that a low score does not preclude the subsequent identification of a CSF leak and as such and thus investigations can be considered in selected cases 4.
Importantly, the score is not intended to predict the likelihood of a patient having spontaneous intracranial hypotension and there is also poor correlation with symptom severity 3. There is, however, a positive correlation between Bern score and opening pressure at lumbar puncture 7.
Scoring system
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major criteria (2 points each)
engorgement of venous sinus
suprasellar cistern 4.0 mm or less
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minor criteria (1 point each)
subdural fluid collection
prepontine cistern 5.0 mm or less
mamillopontine distance 6.5 mm or less
Interpretation
The higher the score the higher the probability of identifying a CSF leak (whether dural tear, meningeal diverticulum, or CSF-venous fistula) at myelography 1,4,5.
0 to 2: low probability (0-7%)
3 to 4: intermediate probability
5 to 9: high probability (67-100%)
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