SIH Score vs CSF

This easy to use, predictive scoring system is based on the six most relevant brain MRI findings and allows to assess the likelihood of a spinal cerebrospinal fluid (CSF) leak in patients with spontaneous intracranial hypotension (SIH). The scoring system may help headache specialists objectively predict the probability of an underling spinal cerebrspinal fluid leak. It is useful to triage patients who may benefit from more invasive myleographic examinations. Spontaneous intracranial hypotension Spontaneous intracranial hypotension (SIH) is an increasingly recognized disorder usually presenting with disabling orthostatic headache, which manifests within minutes after assuming the upright position, and subsides after lying down. According to the common doctrine SIH is triggered by CSF leakage from the intrathecal into the epidural compartment, which is usually due to an osteodiscogenic microspur (calcified disc protrusion or spondylophyte) penetrating the dura, or a leaky spinal nerve root diverticulum. Imaging plays a crucial role in the diagnostic work-up of SIH patients, but many challenges remain, particularly with respect to finding evidence of intracranial hypotension on brain MRI, and identifying and localizing a cerebrospinal fluid (CSF) leak.

The CSF App is providing a competent crash course in CSF data interpretation for neurologists, psyciatrists and clinical chemists. The disease-related data patterns in Reibergrams allow the differential diagnosis of bacterial, viral, parasitic, oncological, chronic inflammatory, autoimmunological and psychiatric diseases. A corresponding commentary to each disease pattern extends the knowledge base. A bed side interpretation software allows data presentation in Reibergrams for IgG,IgA,IgM and in a quotient diagram for free light chain kaqppa. The calculator for antibody Index (AI-) values allows also the interpretation of the combined MRZ - Antibody reactions. The corresponding knowledge bases are published in Reiber H. (2024) Cerebrospinal fluid in Neurology. Paradigm change in brain barriers, immune system and chronic diseases. Essentials Series, Springer (the German version appeared 2023). Reiber H (2016). Cerebrospinal fluid data compilation and knowledge-based interpretation of bacterial, viral, parasitic, oncological, chronic inflammatory and demyelinating diseases: Diagnostic patterns not to be missed in Neurology and Psychiatry. Arq Neuropsiquiatr. 74:337-350