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 of unknown etiology combining headache, focal neurologic symptoms, and lymphocytic pleocytosis, usually in young to middle-aged men. In this clinical article, Dr. Julio Pascual, Director of the Neuroscience Area at the University Hospital Central de Asturias in Oviedo, Spain, reviews the history, clinical manifestations, and practical management of this condition. Particular attention is given to the clinical clues 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, 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 hemicorporal 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.
  • All reported patients with HaNDL recovered completely by 3 months.