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Keskin KG, Carus I, Kalyoncu Aslan I, Gözke E. HaNDL Syndrome: The Innocent Lymphocytic Pleocytosis. Neurologist 2024; 29:163-165. [PMID: 38048553 DOI: 10.1097/nrl.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
INTRODUCTION HaNDL syndrome is a transient and rare condition that presents with neurological deficit and headache accompanied by lymphocytosis on cerebrospinal fluid (CSF) analysis. It is usually characterized by spontaneous recovery without neurological sequelae. This is a benign condition, which has not yet been adequately defined and includes many diseases in the differential diagnosis. We indicated 2 different cases that applied with acute neurological findings. CASE REPORT Two patients who were admitted to our hospital with transient neurological deficits and headaches were evaluated. There was no significant pathology in cranial imaging and EEG reports. Lymphocytic pleocytosis was observed in CSF. Patients were followed up with attacks but were discharged without deficits. We diagnosed the patients with HaNDL syndrome with clinical features, imaging, and laboratory findings. CONCLUSION HaNDL is an underdiagnosed syndrome and it should be considered especially for young patients with headaches is prominent without a risk factor for ischemia, recurrent episodes with neurological symptoms, CSF pleocytosis, and normal imaging findings.Therefore, we wanted to raise awareness for the existence of this rare disease which is a waste of time by performing unnecessary tests and therapies during the diagnosis period.
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Affiliation(s)
- Kadriye Güleda Keskin
- Department of Neurology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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2
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Trimboli M, Troisi L, Caricato A, Della Marca G, Pennisi MA. Acute confusional state in HaNDL syndrome. Neurol Sci 2023; 44:3017-3028. [PMID: 37010670 DOI: 10.1007/s10072-023-06788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE To assess epidemiological, clinical and neuroimaging features of acute confusional state in the Headache and Neurological Deficits with cerebrospinal fluid Lymphocytosis (HaNDL) syndrome. BACKGROUND HaNDL is an increasingly recognized syndrome in which migraine-like headache episodes accompanied by hemiparaesthesia and/or hemiparesis and/or dysphasia are associated to CSF lymphocytic pleocytosis. The International Classification of Headache Disorders (ICHD-3) includes HaNDL syndrome in group 7 "headache attributed to non-vascular intracranial disorder" code 7.3.5, and lists the HaNDL-associated signs/symptoms that may be found less frequently. Confusional state is not mentioned in the 7.3.5-ICHD-3 "notes" or "comments" section as part of the HaNDL neurological spectrum. Moreover, the acute confusional state pathogenesis in HaNDL syndrome remains still uncertain and debated. METHODS Here, we report a 32-year-old male who complained episodes of migraine-like headache and left hemiparaesthesia complicated by confusional state which led to discovering CSF lymphocytosis. Since other workup to determine the cause of his symptoms was otherwise negative, he was diagnosed as having HaNDL syndrome. We also ascertained and reviewed all available reports of HaNDL to assess the significance of confusional state in this syndrome. RESULTS The search yielded 159 HaNDL cases among single reports and small/large series. Out of 159 patients who fulfilled the inclusion criteria for HaNDL according to the current ICHD at the time of diagnosis, 41 (25.7%) presented with acute confusional state. Among 41 HaNDL patients with confusional state, 16 (66.6%) out of 24 who underwent spinal tap had increased opening pressure. CONCLUSION We propose that a mention of acute confusional state may be included in the "comments" section of "7.3.5-syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL)," when ICHD-3 diagnostic criteria will be updated. Moreover, we speculate that intracranial hypertension may play a role in the pathogenesis of the acute confusional state associated to HaNDL syndrome. Larger case series are needed to evaluate this hypothesis.
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Affiliation(s)
- Michele Trimboli
- Institute of Neurology, AOU Mater Domini, Magna Graecia University, Catanzaro, Italy.
| | - Letizia Troisi
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Anselmo Caricato
- Department of Anesthesia and Critical Care, IRCCS, A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giacomo Della Marca
- Department of Neuroscience, IRCCS, A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Mariano Alberto Pennisi
- Department of Anesthesia and Critical Care, IRCCS, A. Gemelli University Polyclinic Foundation, Rome, Italy
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Salazar-Orellana JLI, Prado-Miranda G, Maldonado-Ortiz A. Agraphia: Presenting Feature of Syndrome of Transient Headache and Neurological Deficits With Cerebrospinal Fluid Lymphocytosis (HaNDL). Cureus 2021; 13:e13178. [PMID: 33717723 PMCID: PMC7941604 DOI: 10.7759/cureus.13178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
We report a case of a 48-year-old man with a history of episodes of severe headache, accompanied by motor aphasia and agraphia, with complete recovery between episodes. The neurological examination revealed no abnormality. A lumbar puncture was performed and showed lymphocytic pleocytosis. Cerebrospinal fluid analysis ruled out viral, bacterial, mycobacterial, fungal, treponemal, and NMDA receptor antibodies. Brain magnetic resonance imaging and electroencephalogram revealed no abnormalities. A focal frontotemporal area of hypoperfusion was detected in brain single-photon emission tomography. A diagnosis of syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) was made to the patient and then treated with ibuprofen 400 mg three times per day with excellent response. He remained asymptomatic and free of any relapse during six months of following. We presented a typical case of HaNDL that manifests with agraphia, a transient focal neurological deficit non previously reported. Showing that the clinical picture could probably be any sign and symptom related to focal cortical alteration due to cortical transient hypoperfusion.
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Affiliation(s)
| | - Gala Prado-Miranda
- Department of Neurology, Hospital General de México Dr. Eduardo Liceaga, Mexico City, MEX
| | - Amelia Maldonado-Ortiz
- Department of Neurology, Hospital General de México Dr. Eduardo Liceaga, Mexico City, MEX
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Ghonimi NAM, AbdAlla MA, Fahmi RM. An adult woman with transient headache, neurological deficits, and lymphocytic pleocytosis (HaNDL syndrome) with intracerebral melanosis: case report. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00209-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractHeadache with a neurological deficit and cerebrospinal fluid (CSF) lymphocytosis (HaNDL) is usually under-recognized and under-reported. HaNDL is a self-limiting condition, but the grave symptoms require a large-scale differential diagnosis. We report a case of a 24-year-old female who developed dysarthria for several hours and decreased use of the right arm with right-sided facial weakness. After extensive investigation of blood, CSF, and neuroimaging, we excluded central nervous system infections and autoimmune and vascular diseases. A diagnosis of HaNDL was made according to clinical symptoms and CSF analysis. The prognosis was good, and the symptoms resolved. Repeated physical examination after 48 h was unremarkable. HaNDL is probably not as rare as commonly thought; awareness of its existence can avoid unnecessary and potentially harmful investigations and therapies. The clinical challenge relies on the fact that it remains a diagnosis of exclusion.
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Wang W, Mack HG, Stawell R, White O, Waterston J. HaNDL with bilateral central venous occlusions. BMJ Neurol Open 2020; 2:e000043. [PMID: 33681782 PMCID: PMC7871729 DOI: 10.1136/bmjno-2020-000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background The syndrome of Headache and focal Neurological Deficits with cerebrospinal fluid Lymphocytosis (HaNDL) is considered a rare, idiopathic and self-limited condition. Methods We present a patient with HaNDL who had unique findings of florid optic disc haemorrhages from bilateral central retinal vein occlusions. Results Our patient made a full recovery with conservative management. Conclusion It is important for medical attendants to recognise that HaNDL syndrome can be associated with neuro-ophthalmic complications.
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Affiliation(s)
- Wendy Wang
- Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Heather G Mack
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Stawell
- Eye Surgery Associates, The University of Melbourne, Melbourne, Victoria, Australia
| | - Owen White
- Neuro-Ophthalmology, Monash University, Melbourne, Victoria, Australia
| | - John Waterston
- Neurology, Monash University, Melbourne, Victoria, Australia
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Hidalgo de la Cruz M, Domínguez Rubio R, Luque Buzo E, Díaz Otero F, Vázquez Alén P, Orcajo Rincón J, Prieto Montalvo J, Contreras Chicote A, Grandas Pérez F. Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) in a patient with confusional symptoms, diffuse EEG abnormalities, and bilateral vasospasm in transcranial Doppler ultrasound: A case report and literature review. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
Headache and Neurologic Deficits with cerebrospinal fluid Lymphocytosis (HaNDL) syndrome is a rare stroke mimicker characterized by moderate to severe headache temporally associated with transient neurologic deficits, typically hemiparesis, hemisensory disturbance, and/or aphasia. Cerebrospinal fluid studies reveal a lymphocytosis and elevated protein. Episodes recur over a period no longer than 3 months. Here we describe the case of a 16-year-old boy who presented with 3 episodes of self-resolving neurologic deficits, papilledema on fundoscopic examination, and leptomeningeal enhancement on magnetic resonance imaging (MRI). We additionally review the 30 previously reported pediatric cases of HaNDL syndrome, with a focus on possible etiologic and pathophysiologic mechanisms of disease. The reported case and literature review highlight the benign episodic nature of this likely underrecognized syndrome as well as the higher than expected frequency of abnormal neuroimaging findings.
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Affiliation(s)
- Amy Armstrong-Javors
- 1 Department of Pediatric Neurology, Massachusetts General Hospital, Boston, MA, USA
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Sveinsson O, Säflund M, Sjöstrand C. Moderate to High Levels of Neurofilament Light in Two Patients with HaNDL. Headache 2019; 59:266-267. [PMID: 30602055 DOI: 10.1111/head.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Olafur Sveinsson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Malin Säflund
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Sjöstrand
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Lofaro T, Saha A, Raj K, Dillon R. Non-malignant CSF lymphocytosis in a patient with acute lymphoblastic leukemia. IDCases 2018; 14:e00447. [PMID: 30202728 PMCID: PMC6129732 DOI: 10.1016/j.idcr.2018.e00447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/21/2018] [Accepted: 08/27/2018] [Indexed: 11/23/2022] Open
Abstract
Patients with haematological malignancy are often profoundly immune suppressed, and more so if they require more than one line of therapy. Infection should always be considered when they become unwell. We discuss the differential diagnoses of a young man with multiply-relapsed Philadelphia chromosome-positive B-cell acute lymphoblastic leukaemia who presented with neurological symptoms and cerebrospinal fluid lymphocytosis. The diagnostic approach needs to be rapid and structured, and may require microbiology and neurology support.
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Affiliation(s)
- Thomas Lofaro
- Department of Hematology, Epsom and St Helier University Hospital, UK
| | - Aritra Saha
- Internee at Assam Medical College and Hospital, India
| | - Kavita Raj
- Department of Hematology, Guys and St. Thomas's Hospital, UK
| | - Richard Dillon
- Department of Hematology, Guys and St. Thomas's Hospital, UK
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Hidalgo de la Cruz M, Domínguez Rubio R, Luque Buzo E, Díaz Otero F, Vázquez Alén P, Orcajo Rincón J, Prieto Montalvo J, Contreras Chicote A, Grandas Pérez F. Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) in a patient with confusional symptoms, diffuse EEG abnormalities, and bilateral vasospasm in transcranial Doppler ultrasound: A case report and literature review. Neurologia 2017; 34:536-542. [PMID: 28427768 DOI: 10.1016/j.nrl.2017.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/18/2017] [Accepted: 02/05/2017] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION HaNDL syndrome (transient headache and neurological deficits with cerebrospinal fluid lymphocytosis) is characterised by one or more episodes of headache and transient neurological deficits associated with cerebrospinal fluid lymphocytosis. To date, few cases of HaNDL manifesting with confusional symptoms have been described. Likewise, very few patients with HaNDL and confusional symptoms have been evaluated with transcranial Doppler ultrasound (TCD). TCD data from patients with focal involvement reveal changes consistent with vasomotor alterations. DEVELOPMENT We present the case of a 42-year-old man who experienced headache and confusional symptoms and displayed pleocytosis, diffuse slow activity on EEG, increased blood flow velocity in both middle cerebral arteries on TCD, and single-photon emission computed tomography (SPECT) findings suggestive of diffuse involvement, especially in the left hemisphere. CONCLUSIONS To our knowledge, this is the first description of a patient with HaNDL, confusional symptoms, diffuse slow activity on EEG, and increased blood flow velocity in TCD. Our findings suggest a relationship between cerebral vasomotor changes and the pathophysiology of HaNDL. TCD may be a useful tool for early diagnosis of HaNDL.
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Affiliation(s)
- M Hidalgo de la Cruz
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - R Domínguez Rubio
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - E Luque Buzo
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Díaz Otero
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Vázquez Alén
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Orcajo Rincón
- Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Prieto Montalvo
- Servicio de Neurofisiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Contreras Chicote
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Grandas Pérez
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Babi MA, Applebee A, Shapiro R, Waheed W. Syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis presenting as acute neurological emergencies. Cephalalgia 2016; 37:284-289. [PMID: 27036641 DOI: 10.1177/0333102416642733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) is a self-limited benign disorder of unclear pathogenesis, with diverse clinical manifestations. Cases We report two unusual presentations of this entity. The first case developed a catastrophic picture, characterized by acute elevation of intracranial pressure, necessitating emergency life support. The second case presented with hyperacute-onset mixed aphasia and facial droop, masquerading as acute ischemia of the middle cerebral artery territory. Both patients made full recoveries. Conclusion The possibility of HaNDL should be considered in individuals presenting with unusual patterns of headaches and transient neurological symptoms. Our report will expand the spectrum of this disorder, which will help physicians not only to recognize the unusual manifestations of this rare disorder, but also consider potential therapeutic interventions.
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Affiliation(s)
- M-Alain Babi
- 1 Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA.,2 Division of Neurocritical Care, Department of Neurology, Duke University Hospital, Durham, NC, USA
| | - Angela Applebee
- 1 Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA.,3 Department of Neurology, St-Peter's Hospital, Albany, NY, USA
| | - Robert Shapiro
- 1 Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA
| | - Waqar Waheed
- 1 Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA
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Stelten BML, Venhovens J, van der Velden LBJ, Meulstee J, Verhagen WIM. Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL): A case report with serial electroencephalography (EEG) recordings.. Is there an association with human herpes virus type 7 (HHV-7) infection? Cephalalgia 2016; 36:1296-1301. [DOI: 10.1177/0333102415618616] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) is a diagnosis made by exclusion. In the literature, different etiological explanations are proposed for HaNDL, including an immune-mediated reaction after a viral infection. Case description We present a case of a 23-year-old woman with several episodes of transient headache, neurological deficits and cerebrospinal fluid lymphocytosis. All diagnostic criteria for the HaNDL syndrome were fulfilled; however, additional cerebrospinal fluid analysis showed a positive polymerase chain reaction (PCR) for human herpes virus type 7 (HHV-7). Discussion The possible role of a (prodromal) viral infection in the etiology of HaNDL is discussed. Also the role of electroencephalography (EEG) recordings is discussed. Serial EEG recordings showed generalized slowing, frontal intermittent rhythmic delta activity (FIRDA) and symmetric triphasic frontal waves with a dilation lag.
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Affiliation(s)
- Bianca ML Stelten
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands
| | - Jeroen Venhovens
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands
| | - Lieven BJ van der Velden
- Department of Medical Microbiology, Laboratory for Pathology and Medical Microbiology (PAMM), The Netherlands
| | - Jan Meulstee
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands
| | - Wim IM Verhagen
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, The Netherlands
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Abstract
Headache is infrequent in early childhood. Headache and neurological deficits associated with cerebrospinal fluid (CSF) lymphocytosis (HaNDL), a variant of migraine, is a rare disorder. A 5-year-old boy presented with recurrent episodes of headache for 6 months. Each episode lasted for a week and in the current episode, he was symptomatic for 3 days. All the episodes were associated with paresthesias and CSF lymplocytosis with normal protein and sugar. There was history of migraine in his family. His magnetic resonance imaging (MRI) brain with contrast with magnetic resonance (MR) angiography and venography were normal. Work-up for relevant causes of infection and vasculitis were negative. His symptoms subsided on oral antimigraine prophylaxis and he has been on remission for last 8 months. HaNDL should be considered in relevant clinical scenarios, as it prevents unnecessary investigations, therapy, and hospitalization.
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Affiliation(s)
- Lokesh Saini
- Department of Pediatrics, Child Neurology Division, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjith M Kumar
- Department of Pediatrics, Child Neurology Division, All India Institute of Medical Sciences, New Delhi, India
| | - Biswaroop Chakrabarty
- Department of Pediatrics, Child Neurology Division, All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- Department of Pediatrics, Child Neurology Division, All India Institute of Medical Sciences, New Delhi, India
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Valença MM, de Oliveira DA, Martins HADL. Alice in Wonderland Syndrome, Burning Mouth Syndrome, Cold Stimulus Headache, and HaNDL: Narrative Review. Headache 2015; 55:1233-48. [DOI: 10.1111/head.12688] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Marcelo M. Valença
- Neurology and Neurosurgery Unit, Department of Neuropsychiatry; Federal University of Pernambuco; Brazil
- Neurology and Neurosurgery Unit; Hospital Esperança; Brazil
| | - Daniella A. de Oliveira
- Neurology and Neurosurgery Unit, Department of Neuropsychiatry; Federal University of Pernambuco; Brazil
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Gladstone JP, Dodick DW. Revised 2004 International Classification of Headache Disorders: New Headache Types. Can J Neurol Sci 2014; 31:304-14. [PMID: 15376472 DOI: 10.1017/s031716710000336x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 1988, the International Headache Society created a classification system that has become the standard for headache diagnosis and research. The International Classification of Headache Disorders galvanized the headache community and stimulated nosologic, epidemiologic, pathophysiologic, and genetic research. It also facilitated multinational clinical drug trials that have led to the basis of current treatment guidelines. While there have been criticisms, the classification received widespread support by headache societies around the globe. Fifteen years later, the International Headache Society released the revised and expanded International Classification of Headache Disorders second edition. The unprecedented and rapid advances in the field of headache led to the inclusion of many new primary and secondary headache disorders in the revised classification. Using illustrative cases, this review highlights 10 important new headache types that have been added to the second edition. It is important for neurologists to familiarize themselves with the diagnostic criteria for the frequently encountered primary headache disorders and to be able to access the classification (www.i-h-s.org) for the less commonly encountered or diagnostically challenging presentations of headache and facial pain.
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Taylor FR, Landy SH, Kaniecki RG. Abstracts and Citations. Headache 2013. [DOI: 10.1111/head.12175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Çoban A, Shugaiv E, Tüzün E. Syndrome of Headache Accompanied with Transient Neurologic Deficits and Cerebrospinal Fluid Lymphocytosis. Noro Psikiyatr Ars 2013; 50:S52-S55. [PMID: 28360585 DOI: 10.4274/npa.y7228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 06/07/2013] [Indexed: 12/01/2022] Open
Abstract
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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Affiliation(s)
- Arzu Çoban
- İstanbul University Istanbul Medical Faculty, Department of Neurology, İstanbul, Turkey
| | - Erkingül Shugaiv
- İstanbul University Istanbul Medical Faculty, Department of Neurology, İstanbul, Turkey
| | - Erdem Tüzün
- İstanbul University Experimental Research Institute (DETAE), Department of Neuroscience, İstanbul, Turkey
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Filina T, Feja KN, Tolan RW. An adolescent with pseudomigraine, transient headache, neurological deficits, and lymphocytic pleocytosis (HaNDL Syndrome): case report and review of the literature. Clin Pediatr (Phila) 2013; 52:496-502. [PMID: 23559488 DOI: 10.1177/0009922813483358] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a 16-year-old adolescent with 2 episodes of focal neurological deficits, pseudomigrainous headache, and lymphocytic pleocytosis due to the syndrome of transient headache and neurological deficits with cerebrospinal fluid (CSF) lymphocytosis (HaNDL), also known as pseudomigraine with CSF pleocytosis. Review of the literature identifies 13 additional cases of HaNDL in the pediatric population. These cases are reviewed and evidence for possible etiopathogenesis is discussed. This syndrome may mimic much more common conditions such as complicated or hemiplegic migraine, aseptic meningitis, meningoencephalitis, or stroke. However, HaNDL differs from complicated or hemiplegic migraine and stroke since CSF pleocytosis is uniformly present. There are many infectious conditions that can present with neurological deficits, headache, and CSF pleocytosis, but the transient nature of the deficits and lack of a consistently identifiable infectious etiology despite extensive evaluations typify HaNDL. This clinical syndrome is underrecognized and underreported. HaNDL remains a diagnosis of exclusion.
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Affiliation(s)
- Tatiana Filina
- The Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ 08901, USA
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Parissis D, Ioannidis P, Balamoutsos G, Karacostas D. Confusional State in the Syndrome of HaNDL. Headache 2011; 51:1285-8. [DOI: 10.1111/j.1526-4610.2011.01884.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Diener HC, Johansson U, Dodick DW. Headache attributed to non-vascular intracranial disorder. HANDBOOK OF CLINICAL NEUROLOGY 2010; 97:547-587. [PMID: 20816456 DOI: 10.1016/s0072-9752(10)97050-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This chapter deals with non-vascular intracranial disorders resulting in headache. Headache attributed to high or low cerebrospinal fluid pressure is separated into headache attributed to idiopathic intracranial hypertension (IIH), headache attributed to intracranial hypertension secondary to metabolic, toxic, or hormonal causes, headache attributed to intracranial hypertension secondary to hydrocephalus, post-dural puncture headache, cerebrospinal fluid (CSF) fistula headache, headache attributed to spontaneous (or idiopathic) low CSF pressure. Headache attributed to non-infectious inflammatory disease can be caused by neurosarcoidosis, aseptic (non-infectious) meningitis or lymphocytic hypophysitis. Headache attributed to intracranial neoplasm can be caused by increased intracranial pressure or hydrocephalus caused by neoplasm or attributed directly to neoplasm or carcinomatous meningitis. Other causes of headache include hypothalamic or pituitary hyper- or hyposecretion and intrathecal injection. Headache attributed to epileptic seizure is separated into hemicrania epileptica and post-seizure headache. Finally headache attributed to Chiari malformation type I (CM1) and the syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) are described.
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Guilloton L, Didelot A, Gouillou A, Felten D, Drouet A. Syndrome de céphalées et déficits neurologiques transitoires avec lymphocytose du liquide céphalorachidien. Rev Med Interne 2008; 29:397-400. [DOI: 10.1016/j.revmed.2007.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 11/06/2007] [Indexed: 10/22/2022]
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Young WB, Silberstein SD. MIGRAINE. Continuum (Minneap Minn) 2006. [DOI: 10.1212/01.con.0000290524.54826.fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Barroso B, Bertandeau E, Zerbib JL, Larribau E, Dakar A, Larrieu JM. [Pseudomigraine with transient neurological deficits and cerebrospinal fluid lymphocytosis]. Rev Neurol (Paris) 2005; 161:1102-5. [PMID: 16288175 DOI: 10.1016/s0035-3787(05)85177-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis is a rare syndrome resolving within less than 3 months. CASE REPORT A young 17-year-old woman without previous medical history was admitted to the hospital because of right motor weakness and language disturbances. The symptoms resolved in a few hours and were followed by severe left headaches with important vegetative signs. Several similar episodes were noted in the previous 10 days. Cranial MRI was normal. EEG showed important slowing of the cerebral electrogenesis. More than 250 lymphocytic cells were found at CSF analysis. Outcome was spontaneously favorable, without similar symptoms after 6-month follow-up. CONCLUSION Pseudomigraine with lymphocytic pleocytosis seems to be a particular syndrome of unknown origin. This is an elimination diagnosis, generally with a benign course.
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Affiliation(s)
- B Barroso
- Service de Neurologie, Centre Hospitalier François Mitterrand, Pau Université.
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Tada Y, Negoro K, Abe M, Ogasawara JI, Kawai M, Morimatsu M. A patient of migraine-like headache with amnesia, pleocytosis and transient hypoperfusion of cerebral blood flow. Intern Med 2005; 44:743-6. [PMID: 16093598 DOI: 10.2169/internalmedicine.44.743] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pseudomigraine with pleocytosis (PMP) is an uncommon disease in Japan. The diagnostic criteria include at least one episode of transient neurological deficit accompanied or followed by migraine-like severe headache, cerebrospinal fluid (CSF) lymphocytosis, and normal neuroimaging. Both the etiology and the pathophysiology of PMP is not yet well defined. We report a 40-year-old man with a PMP-like syndrome. He came to our clinic because of severe throbbing headache and amnesia, and the examination showed CSF lymphocytosis of 23/mm3, a transient decrease of cerebral blood flow in the left thalamus. All the symptoms were completely resolved within 2 months.
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Affiliation(s)
- Yukiko Tada
- Department of Neurology and Clinical Neuroscience, Yamaguchi University, Ube, Yamaguchi
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Abstract
Hemiplegic migraine may be familial or sporadic. Both forms share a similar spectrum of clinical presentations and genetic heterogeneity. Current data support the concept that sporadic and familial cases should be thought of as similar, but separate disorders. Sporadic cases are more difficult to diagnose and often require several investigations to rule out more ominous possibilities. Therapeutic options are limited, but future genetic research may elucidate pathophysiologic mechanisms that may, in turn, yield more specific treatments.
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Affiliation(s)
- David F Black
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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