Focal CT hypoperfusion in HaNDL

Headache with transient neurological deficit: a case report with hemispheric hypoperfusion and without lymphocytosis

“…In conclusion, in this case, as shown in previous reports [5], we have observed cerebral hypoperfusion during the acute state of an incomplete form of HaNDL, a rare but probably under-recognized syndrome. This information and the possible absence of lymphocytosis might be considered in the future revision of ICHD.…”

“…Existence of hypoperfusion in the entire left cerebral hemisphere in an area not restricted to a vascular territory, and the absence of a lesion restricted in DWI with a complete perfusion/diffusion mismatch rule out an acute stroke [4]. This pattern in a whole hemisphere with patterns of benign oligemia rather than ischemia has been previously described during a HaNDL attack [4,5].…”

The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis mimicking an acute stroke

“…In isolated case reports, perfusion CT and MRI have proved useful for differential diagnosis between HaNDL syndrome and stroke when global hemispheric hypoperfusion is present [6][7][8]. However, in a previously published case report, which is included in our series, perfusion CT study showed focal hypoperfusion that was indistinguishable from AIS [9]. The largest HaNDL syndrome series with perfusion CT performed in the acute setting to date is presented.…”

“…Isolated case reports have previously shown that cranial perfusion computed tomography (CT) and MRI perfusion can help to distinguish between them when global hemispheric hypoperfusion is present in HaNDL [6][7][8]. However, recently a patient with HaNDL syndrome was reported by us in whom perfusion CT showed a focal hypoperfusion that was indistinguishable from AIS [9].…”

Alice in Wonderland Syndrome, Burning Mouth Syndrome, Cold Stimulus Headache, and HaNDL: Narrative Review

“…Three decades after the first clear description of this syndrome its etiopathogenesis remains unknown. Initially, transient neurological deficits were interpreted as the result of local cortical hypoperfusion due to the Leão spreading depression phenomenon in migraineurs . However, most individuals with the syndrome are not migraineurs and there is a prevalence in males; this is at odds with the idea that HaNDL represents a complication of a migraine attack with a prolonged aura.…”