Syndrome of Transient Headache and Neurologic Deficits With Cerebrospinal Fluid Lymphocytosis (HaNDL)

Abstract

The syndrome of transient headache and neurologic deficits associated with cerebrospinal fluid lymphocytosis (HaNDL) is characterized by 1 or more episodes of severe headache, transient neurologic deficits, and lymphocytic pleocytosis in the cerebrospinal fluid. It is a benign and self limited disorder seldom reported in pediatric age. We report the case of a 14-year-old girl who suffered from 2 episodes of headache with transient focal neurologic deficits and pleocytosis consistent with the syndrome of HaNDL. This entity should be taken into account as a differential diagnosis in otherwise healthy children presenting with recurrent headache and acute neurologic deficits. Repeated use of invasive and expensive laboratory and imaging investigations can be avoided when the diagnosis of the syndrome of HaNDL is correctly established.

Altered conscious state as a presentation of the syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) in a paediatric patient

“…CSF culture and infective PCRs are negative. CSF lymphocytosis resolves over time, although the duration is unknown . Routine CT and MRI brain must be normal .…”

“…Headache and neurological deficits with CSF lymphocytosis is most commonly diagnosed in the third or fourth decades of life and is rare in the paediatric population . Only 16 paediatric cases have previously been published .…”

“…Headache and neurological deficits with CSF lymphocytosis is most commonly diagnosed in the third or fourth decades of life and is rare in the paediatric population . Only 16 paediatric cases have previously been published . A combative or altered conscious state is a rare neurological feature of HaNDL, and only nine cases have been reported, of which one was a paediatric patient …”

HaNDL syndrome in a 14-year-old girl

“…Treatment is symptomatic and supportive with all patients recovering within 1–84 days with only a few patients experiencing recovery 2 18. Because the disease is self-limiting, education and reassurance of the patient and family are very important.…”

Complicated Migraine

“…51 It is more common in adults aged 30À40 years, although cases in children have been reported. 52,53 Its features include severe deficits involving differing vascular territories, with concomitant CSF pleocytosis and no MRI evidence of infarction. Attacks can range from a few hours to 2À3 days.…”