Neurologic Deficits and cerebrospinal fluid (CSF) lymphocytosis (HaNDL): a comprehensive systematic review of 93 patients from 57 studies (P3-12.003)

A stroke mimic with left-hemispheric leptomeningeal vessel paucity and hypoperfusion

“…The left hemisphere is more commonly affected [9] . Diffuse slowing on EEG may be observed in nearly half of the cases [8] . Neuroimaging abnormalities associated with HaNDL are uncommon and heterogeneous, including brain hypoperfusion and leptomeningeal signal abnormalities [ 8 , 9 ].…”

“…Diffuse slowing on EEG may be observed in nearly half of the cases [8] . Neuroimaging abnormalities associated with HaNDL are uncommon and heterogeneous, including brain hypoperfusion and leptomeningeal signal abnormalities [ 8 , 9 ]. In addition, diffuse left-hemispheric hypoperfusion on CTP [ 10 , 11 ] and paucity of leptomeningeal veins on SWI [12] have also been reported.…”

“…In contrast, it is accompanied by an increased prominence of the corresponding leptomeningeal veins on MRI susceptibility-weighted imaging (SWI). HaNDL (Headache with Associated Neurological Deficits and CSF Lymphocytosis), characterized by paroxysmal headache and transient neurological deficits (confusion and aphasia among the most common), associated with leukocytosis and elevated protein in CSF [8] . The left hemisphere is more commonly affected [9] .…”

“…The pathophysiology of the association between headaches, neurological deficits, and vascular abnormalities remains unclear [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] . Of note, the appearance of a nonspecific white matter lesion in our patient may result from microischemic changes in the most severe focus of hypoperfusion.…”