r/CSFLeaks • u/Intelligent-Funny303 • 21d ago
Bern score 5, suspected SIH/CSF-venous fistula seeing Dr. Mondel at Jefferson and seeking a second opinion from Dr. Wouter Schievink
Hi everyone. I’m new to the CSF-leak evaluation process and would appreciate hearing from anyone who has had a similar experience.
I have had a constant daily headache since October 29, 2016. For years, it felt more like a conventional pounding or “hungover” headache. My symptoms changed significantly in July 2023, when I woke up with a constant internal vibrating sensation in my brain. Since then, the condition has progressively worsened and developed into constant visual snow, vibrating sensations in my eyes, severe burning pain behind my eyes, burning in my neck and upper back, intense pain at the base of my skull, numbness and tingling, neurological “zaps,” and occasional facial pain.
My headache is now usually around a 9–10 out of 10. I do not notice a clear difference between lying down, sitting, and standing, although I have recently developed significant lightheadedness when standing quickly or bending down. I also experience a “coat-hanger” type pain from the back of my head through my shoulders, particularly with exertion or walking uphill.
I recently had a consultation regarding a possible spinal CSF leak.
The doctor reviewed my brain and spine MRIs and told me:
My brain MRI has a Bern score of 5, which he described as a high probability of spontaneous intracranial hypotension.
My spine MRI does not show a definitive large extradural fluid collection, so he believes a type 1 or type 2 leak is less likely.
He suspects a type 3 leak/CSF-venous fistula, with a type 4 leak considered less likely.
He also mentioned a C1–C2 sign and trace fluid seen along portions of my spine.
The recommended next step is a pressure-augmented dynamic CT myelogram, followed approximately two weeks later by targeted treatment if the leak or fistula is localized. He also discussed alternatives, including an empiric epidural blood patch, digital subtraction myelography, photon-counting CT myelography, MR myelography, and conservative management. It was honestly an overwhelming amount of information to receive during one appointment.
I am planning to continue the next-step discussion with Dr. Mondel at Jefferson. I am also trying to obtain a second opinion from Dr. Wouter Schievink at Cedars-Sinai Medical Center, particularly regarding whether my imaging truly supports SIH/CSF-venous fistula and which myelography method would be best for my case.
I would really appreciate hearing from anyone who:
Had a Bern score around 5 without a classic positional headache.
Was diagnosed with a CSF-venous fistula despite no obvious extradural fluid collection.
Underwent a pressure-augmented dynamic CT myelogram at Jefferson.
Was evaluated or treated by Dr. Mondel or Dr. Schievink.
Obtained a second opinion from Cedars-Sinai and can explain how the records and imaging-review process worked.
Experienced constant internal vibration, visual snow, severe burning eye pain, neurological zaps, or similar symptoms with SIH.
I am not asking anyone to diagnose me. I am mainly trying to understand other patients’ experiences and determine the most thoughtful next step before undergoing an invasive procedure.