Usefulness of multimodal MR imaging in the differential diagnosis of HaNDL and acute ischemic stroke

Segura, Tomás; Hernández-Fernández, F.J.; Sánchez-Ayaso, P.A.; Lozano, Elena; Abad, Lorenzo

doi:10.1186/1471-2377-10-120

Cited by 33 publications

(33 citation statements)

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“…Episodes recur in a period of several weeks, being lymphocytosis in cerebrospinal fluid and complete remission key diagnostic criteria. Pathophysiology is unknown, although recently, acute global hemispheric hypoperfusion has been reported, suggesting an unstable arteriolar vasoreactivity [20,23]. HaNDL syndrome is a difficult diagnosis, as the lumbar puncture required for confirmation would contra-indicate subsequent therapy with IV-tPA.…”

Section: Discussionmentioning

confidence: 99%

“…This entity, acknowledged by the International Headache Society, presents as reversible neurological deficits accompanied or followed by migraine-like headache, and may mimic IS especially in the first episode [19,20,21,22]. Episodes recur in a period of several weeks, being lymphocytosis in cerebrospinal fluid and complete remission key diagnostic criteria.…”

Section: Discussionmentioning

confidence: 99%

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Stroke Mimics Treated with Thrombolysis: Further Evidence on Safety and Distinctive Clinical Features

et al. 2012

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Background: Patients who present with symptoms mimicking ischaemic stroke (IS), but have a different diagnosis, are known as stroke mimics (SM). The necessity for rapid administration of intravenous thrombolysis in patients with acute IS may lead to treatment of patients with conditions mimicking stroke. A variable proportion of patients with SM (1.4–14%) are currently treated with intravenous tissue plasminogen activator therapy (IV-tPA). The outcome of these patients is generally favourable and complications are rather infrequent. We aimed to determine the frequency, clinical features and prognosis of SM patients treated with IV-tPA in an experienced stroke centre. Methods: A prospective registry was assembled with patients treated with IV-tPA at our stroke unit from January 2004 to December 2011. We recorded age, gender, baseline National Institutes of Health Stroke Scale (NIHSS) score, treatment delay, vascular risk factors, clinical syndrome and aetiology. We retrospectively analysed the clinical characteristics of SM, safety (symptomatic intracranial haemorrhage and mortality) and outcome measures (modified Rankin Scale at 3 months, mRS) and compared them with IS patients. Results: 621 patients were treated with IV-tPA during the study period, 606 (97.5%) were IS and 15 (2.4%) were SM. The aetiology of SM was somatoform disorders (5), headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome (3), herpetic encephalitis (2), glial tumours (2), and migraine with aura, focal seizure and cortical vein thrombosis in single cases. SM were younger (72 ± 14 vs. 53.7 ± 16 years, p < 0.05), had a lower baseline deficit [NIHSS 13 (9–18) vs. 8 (5–10), p < 0.05], fewer vascular risk factors, and left hemisphere symptoms were predominant (80 vs. 52.4%, p < 0.05). Global aphasia without hemiparesis (GAWH) was the presenting symptom in 8 (54%) SM and 44 (7%) IS (p < 0.05). Multimodal computed tomography was performed in 3 SM patients and showed perfusion deficits in 2 of them. No intracranial haemorrhage or disability (functional outcome at 3 months, mRS >2) was recorded in any SM patient. Conclusions: The use of intravenous thrombolysis appears to be safe in our SM patients, and prognosis is universally favourable. Somatoform disorder and HaNDL syndrome were prominent causes, and GAWH the most common presentation. The safety of thrombolysis in SM suggests that delaying or withholding treatment may be inappropriate: the benefit of thrombolysis in case of IS may outweigh the risks of treating an SM. Further studies may assess the future role of multimodal computed tomography in the differential diagnosis between IS and SM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stroke Mimics Treated with Thrombolysis: Further Evidence on Safety and Distinctive Clinical Features

et al. 2012

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“…MR-angiography has also shown discrepancies between cerebral vessel diameter, with the affected side having reduced diameter 16. Transcranial Doppler sonography during and after an attack has shown asymmetrical fluctuations in the middle cerebral artery blood flow velocity and pulsatility indicating that intracranial vasomotor changes similar to those found in migraine with aura may play a role in the pathogenesis of HaNDL 16 17…”

Section: Discussionmentioning

confidence: 99%

HaNDL syndrome in a 14-year-old girl

2016

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Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) consists of recurrent headaches with focal neurological signs, which can include motor, sensory and aphasic symptoms. Although considered rare, it is becoming increasingly recognised in clinical practice due to the accumulation of case reports. The pathophysiology remains unclear although changes in the neurovascular resemble those found in migraine, which are thought to be triggered by an infectious process. HaNDL can mimic various serious, including life-threatening, diseases, such as stroke and meningoencephalitis, which is why vigorous tests should be sought before this diagnosis of exclusion can be reached. Treatment is symptomatic and the prognosis is excellent. A literature review of the topic is discussed. We report an adolescent girl who presented with recurrent expressive dysphasia and right-sided hypoaesthesia and moderate occipital headaches who was diagnosed with HaNDL syndrome.

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“…Kranyal diffüzyon ağırlıklı manyetik rezonans görüntüleme (MRI) incelemelerinin normal olmasına rağmen (14,15,16,17); perfüzyon ağırlıklı incelemelerde bozuklukların olduğu son zamanlarda yayınlanan çalışmalarda bildirilmiştir (14,16,17). Tek olguluk başka bir çalışmada ise, korpus kallozum splenium bölgesinde diffüzyon kısıtlılığı gösterilmiştir (18).…”

Section: Klinik Tablo Ve Epidemiyolojiunclassified

Beyin Omurilik Sıvısı Lenfositozu ve Geçici Nörolojik Bulguların Eşlik Ettiği Baş Ağrısı Sendromu

Çoban

Shugaiv

Tüzün

2013

npa

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The syndrome of headache accompanied with transient neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL), is a rare, benign and self limiting syndrome. In the 2nd Edition of the International Classification of Headache Disorders, HaNDL syndrome was defined in secondary headache group as "Headache attributed to non-vascular intracranial disorder". The etiology of HaNDL is still unknown. In recent years, some authors have shown that ion channel autoimmunity might at least partially contribute to HaNDL pathogenesis. In this paper, the definition of HaNDL syndrome, clinical picture and epidemiology of HaNDL syndrome, etiopathogenesis, differential diagnosis and treatment will be reviewed with the recent literature.

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Usefulness of multimodal MR imaging in the differential diagnosis of HaNDL and acute ischemic stroke

Cited by 33 publications

References 10 publications

Stroke Mimics Treated with Thrombolysis: Further Evidence on Safety and Distinctive Clinical Features

Stroke Mimics Treated with Thrombolysis: Further Evidence on Safety and Distinctive Clinical Features

HaNDL syndrome in a 14-year-old girl

Beyin Omurilik Sıvısı Lenfositozu ve Geçici Nörolojik Bulguların Eşlik Ettiği Baş Ağrısı Sendromu

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