Rare mimicker of transient ischaemic attacks: the syndrome of transient headache and neurological deficits with cerebrospinal luid lymphocytosis

The syndrome of transient headache and neurologic deficits associated with cerebrospinal fluid lymphocytosis (HaNDL) is a benign and self limiting disorder characterized by 1 or more episodes of severe headache and transient neurologic deficits with lymphocytic pleocytosis in the cerebrospinal fluid. We report a case of a 30-year-old male who presented with four episodes of headache followed by hemi paresis and hemisensory loss in a week the patient was completely asymptomatic in between each episode of headache with neurological deficits. Persistent serial imaging to visualize the brain were normal with evidence of cerebrospinal fluid lymphocytosis, which lead to the diagnosis of HaNDL. We need to advocate a high degree of suspicion for HaNDL in the background of strong clinical history and findings, when imaging is normal.

Síndrome de cefalea y déficit neurológico transitorio con pleocitosis linfocitaria en líquido cefalorraquídeo, caso clínico y revisión de la literatura / Syndrome of transient Headache and Neurological Deficits with cerebrospinal fluid Lymphocytosis: A Case report and review of the literature

RESUMEN El síndrome de cefalea asociado a déficit neurológico y linfocitosis en el líquido cefalorraquídeo, HaNDL, por sus siglas en inglés, es una entidad de reciente descripción. Sin embargo ya está incluida en la última clasificación internacional de cefaleas y parece tener una distribución mundial. Presentamos a continuación el primer caso descrito en la literatura latinoamericana para que sus características sean tenidas en cuenta en el abordaje diagnóstico de las cefaleas.

SUMMARY The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis, HaNDL, is a recently described entity. However, it's already included in the last international classification of headaches disorders (ICHD 3rd edition beta version) and seems to have a worldwide distribution. We describe the first case in Latin American literature, so its clinical features are taken into account in the diagnostic approach of headaches syndromes.

Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis mimicking dengue encephalitis in a child.

The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) has been infrequently reported in children. This condition can mimic many serious conditions of the central nervous system, while actually being benign in nature. The authors present the report of an 8 year old developmentally normal female with family and personal history of migraine, which was initially suspected to have Dengue encephalitis. She had an episode of seizures, meningism and altered sensorium. Normal mental status and physical findings were observed intermittently. Detailed evaluation including analysis of blood, cerebrospinal fluid (CSF) and neuroimaging were done. Neuro-infections, vascular pathology and autoimmune disorders were ruled out prior to reaching a diagnosis of HaNDL. She responded well to symptomatic treatment and made a full recovery. She was discharged on migraine prophylaxis considering her history. Dengue as causation and the occurrence of seizures in HaNDL has not been reported previously.