Bern SIH Score Peaks Early Then Fades: Timing Matters for MRI Interpretation in Intracranial Hypotension

In 220 spontaneous intracranial hypotension patients, Bern SIH score peaked at ~4–9 weeks of symptoms (median score 8–7) then fell by >1 year (median score 4). A low score in long-standing disease should not rule out SIH — imaging findings are time-dependent.

• Retrospective cross-sectional study (n=220; mean age 51±14 yrs, 65% female) from a single academic center; median symptom duration at baseline MRI was 5 weeks (IQR 2–19).
• Ordinal logistic regression with restricted cubic splines confirmed a nonlinear trajectory: scores rose early then declined; after adjustment for clinical factors, statistical significance was lost, though the temporal pattern remained consistent.
• Key limitation: retrospective single-center design with no external validation; adjusted models did not reach statistical significance, limiting causal inference.

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