Headache associated with neurologic deficits and CSF lymphocytosis

Introduction
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By Julio Pascual MD

Headache associated with neurologic deficits and CSF lymphocytosis (HaNDL) is also known as or subsumes Pseudomigraine. -ed.

Headache associated with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL), also known as pseudomigraine with pleocytosis, is a benign but spectacular syndrome, thought to be of autoimmune etiology, combining headache, focal neurologic symptoms, and lymphocytic pleocytosis, usually in young to middle-aged men. In this clinical article the author reviews the history, clinical manifestations, and practical management of this condition, which is 1 of the most frequent stroke mimics treated with thrombolysis. Particular attention is given to the new diagnostic criteria and the role of neuroimaging techniques for its diagnosis.

Key Points

  • Headache associated with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL) is a self-limited syndrome that is characterized by a sudden onset of headache with temporary neurologic deficit and CSF lymphocytosis.
  • Headache may be bilateral or hemicranial. It lasts an average of 19 hours, and it may be accompanied by nausea, vomiting, photophobia, or phonophobia, but most patients do not report a history of migraine headaches.
  • Sensory symptoms, language disorders, and hemicorporeal weakness lasting a mean of 5 hours are the more frequent focal deficits.
  • The diagnosis of HaNDL is made after excluding more common conditions that present with headache and transient neurologic signs and symptoms.
  • HaNDL is 1 of the most frequent stroke mimics treated with thrombolysis.
  • All reported patients with HaNDL recovered completely without treatment by 3 months.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors