[Japanese Guideline for Traumatic Intracranial Hypotension:Interpretation and Current Situation].

Abstract

Since the 2000s, "intracranial hypotension syndrome associated with trauma" has become a social problem in relation to litigation and compensation issues in Japan. To address this problem, guidelines for correct diagnosis have been developed. The basic pathogenesis of this disease is cerebrospinal fluid leakage caused by fragile tissue injury due to trauma. In order to improve the treatment outcome of this disease, it is important to prove the CSF leakage directly, using diagnostic imaging based on the guidelines, rather than diagnosing it based on clinical manifestations alone. For management, an epidural blood patch(EBP)should be used only after careful consideration. As such, rest and adequate fluid replacement should generally be given first. However, in cases with concomitant subdural hematoma, the order of hematoma irrigation and EBP should be determined according to the condition and urgency of each patient. In addition, it is necessary to standardize the formal name of this condition in papers to ensure rigorous academic discussion.