Negative correlation between the Bern score and opening pressure in myelography positive spontaneous intracranial hypotension

Abstract

Abstract Objective The Bern score is based on brain magnetic resonance imaging (MRI) to predict the probability of cerebrospinal fluid (CSF) leak in spontaneous intracranial hypotension (SIH). The aim of this study is to investigate the association between lumbar puncture opening pressure (OP) and the Bern score. Methods We retrospectively reviewed OP measurement records and neuroimaging of patients with SIH in our center. The Bern score and its components were measured based on contrast‐enhanced brain MRI. The associations between OP and the Bern score, as well as its components, were analyzed. Patients were divided as low‐pressure (LP) group (OP < 60 mmH2O) and not‐low‐pressure (NLP) group (OP ≥ 60 mmH2O). Differences in terms of the Bern score and its components were compared between the two groups. Results Seventy‐one (mean age 40.4 ± 10.6 years) patients with myelography confirmed CSF leak were included in this study. The mean disease duration when performed brain MRI was 32 ± 29 days, with a mean Bern score of 5.1 ± 2.7 and a mean OP of 68.6 ± 60.3 mmH2O. There are statistically negative correlations between OP and the Bern score (p < .001), as well as suprasellar cistern (p < .01) and prepontine cistern (p < .01). The presence of venous engorgement (p < .01) and pachymeningeal enhancement (p < .001) were significantly associated with OP. The LP groups have higher Bern scores than the NLP group (5.9 ± 2.5 vs. 4.2 ± 2.6, p = .004). Conclusions A higher Bern score is indicative of not only an increased likelihood of a CSF leak but also a greater probability of low OP in patients with SIH. For patients with a Bern score ≥5 and positive heavily T2‐weighted MR myelography findings, epidural blood patch is reasonable before invasive myelography.

Keywords

• brain magnetic resonance imaging
• cerebrospinal fluid leak
• opening pressure
• spontaneous intracranial hypotension