The Transient Syndrome of Headache with Neurologic Deficits and CSF Lymphocytosis

ABSTRACT

In 1981, Bartleson et al described seven patients who experienced three to 12 episodes of headache accompanied by neurologic deficits and CSF lymphocytosis. The headache pain was severe and of a type not previously experienced by the patients. The neurologic deficits were temporary, usually lasting hours and at most 3 days. The CSF showed a predominantly lymphocytosis and increased protein. We report a patients of this syndrome. A 39 year-old woman without a history of migraine developed a right-sided severe headache with weakness in the right extremities. Three days earlier she had an upper respiratory infection. At admission she had a fever. Her speech was dysarthric. She had left homonymous hemianopsia, left-sided hemiparesis and hypoesthesia. Lumbar puncture revealed 180 WBCs (90% lymphocytes) and total protein 132 mg/dl. The symptoms and signs cleared completely within 18 hours. Three days later, she experienced left-sided severe headache followed 1 hour later by confusion after cerebral angiogram. Her language showed Wernicke's aphasia. A repeat lumbar puncture revealed similar result to first attack. The symptoms again cleared two days later. She has remained free of symptoms for 28 months. This syndrome is a self-limited condition, but the etiology of this syndrome is unknown. The monophasic nature and a high frequency of an associated fever and viral illness favor infectious origin.