Migraine and CSF pleocytosis

Headache with neurological deficits and CSF lymphocytosis: A transient ischemic attack mimic

Headache with neurological deficits and cerebrospinal fluid (CSF) lymphocytosis (HaNDL) is a benign condition with a transient ischemic attack (TIA)-like presentation. It is a disease of young adults that is characterized by headache, transient focal neurological symptoms, and lymphocytic pleocytosis. The onset of neurological symptoms after cerebral angiography in patients with this disease has occasionally been reported. The authors present the case of a 28-year-old man with episodes of left-sided numbness and weakness associated with headache. He underwent cerebral angiography as part of his evaluation, after which he experienced an episode of right hemiplegia and aphasia. A subsequent magnetic resonance image (MRI) revealed two small new infarcts in the left parietal cortex. A diagnosis of HaNDL was made based mainly on clinical symptoms and CSF analysis. The symptoms resolved with conservative therapy. HaNDL is a benign condition that can present with symptoms similar to a TIA. Although HaNDL remains a diagnosis of exclusion, caution is required when considering cerebral angiography in the evaluation of patients with a HaNDL-like syndrome, because these patients seem prone to developing neurological symptoms after angiography.

Cerebrospinal-fluid abnormalities associated with migraine

Cerebrospinal-fluid (CSF) abnormalities have been reported infrequently in patients with migraine. Four cases of CSF pleocytosis and raised pressure found in young women during the course of an attack of protracted prodromal migraine, which was followed by complete recovery, are reported. In the absence of any other detectable cause, the CSF changes were attributed to the effects of the migrainous process on meningeal vascular permeability.

Transient neurological symptoms associated with mononuclear pleocytosis of the cerebrospinal fluid

Brief episodes of neurological dysfunction may sometimes occur in an afebrile patient with no overt vascular disorder, nor any history of previous migraine. In such a case, the cerebrospinal fluid (CSF) may exhibit a predominantly lymphocytic pleocytosis with plasma cells and an increased protein content indicating a lesion of the blood-brain barrier. This syndrome of remitting hemispheric dysfunction is accompanied by migraine-like headache. The available evidence suggests that an aseptic meningitis is the triggering event.

Migraine, Tolosa-Hunt syndrome and pleocytosis. Correlation or coincidence?

A critical analysis is presented of the problem whether the migraine attack causes CSF-pleocytosis or vice versa, on the basis of a series of 3 cases, including one of Tolosa-Hunt syndrome due to sarcoidosis, the other two ultimately showing chronic leptomeningitis. The evidence leads to the conclusion that migraine does not cause pleocytosis and pleocytosis does not cause migraine: both are correlated by an underlying common denominator.