Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Sharma R, Deng F, Headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome. Reference article, Radiopaedia.org (Accessed on 29 Mar 2024) https://doi.org/10.53347/rID-63980
Headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome is a rare condition characterized by recurrent headaches associated with focal neurological deficits.
The condition typically occurs in young adults aged 30-40 years, and has a slight male predilection 8.
The core clinical features include 8:
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migraine-like headache which is often severe in intensity, throbbing in character, and lasting hours to short days
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transient neurological deficits such as hemiparesis, hemisensory disturbances, aphasia, and visual symptoms
CSF analysis, by definition, reveals a lymphocytic pleocytosis (>15 white cells/mL) 8. The degree of pleocytosis correlates with the severity of the symptoms 8.
The pathophysiology remains unclear although changes in the neurovascular resemble those found in migraine, which may be triggered by an infectious process 8.
MRI
MRI brain is normal in approximately 75% of cases 8. One case report of abnormalities included grey matter swelling, sulcal leptomeningeal enhancement, and hypoperfusion involving unilateral temporal and occipital regions 7. Another case report described reduced venous susceptibility artifact in the symptomatic hemisphere, the opposite to what may be seen in some patients with migraine 9.
Treatment and prognosis
Treatment is symptomatic and the prognosis is considered excellent 8.
Clinically can mimic various serious, including life-threatening, diseases, such as stroke or meningoencephalitis.
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1. Cifelli A, Vaithianathar L. Syndrome of transient Headache and Neurological Deficits with cerebrospinal fluid Lymphocytosis (HaNDL). (2011) BMJ case reports. doi:10.1136/bcr.03.2010.2862 - Pubmed
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2. Cifelli A, Vaithianathar L. Syndrome of transient Headache and Neurological Deficits with cerebrospinal fluid Lymphocytosis (HaNDL). (2011) BMJ case reports. doi:10.1136/bcr.03.2010.2862 - Pubmed
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3. Rivero-Sanz E, Pias-Peleteiro L, Gonzalez-Alvarez V. HaNDL syndrome in a 14-year-old girl. (2016) BMJ case reports. doi:10.1136/bcr-2015-213018 - Pubmed
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4. Al Hadidi M, Meng WD, Jumean K, Hawatmeh A. Syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis masquerading as meningitis in HIV patient. (2017) Annals of translational medicine. 5 (6): 138. doi:10.21037/atm.2017.03.18 - Pubmed
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5. Tsang BK, Kwong JC, Dewey HM. Case of syndrome of headache with neurological deficits and cerebrospinal fluid lymphocytosis (HaNDL) with focal slowing on electroencephalogram. (2012) Internal medicine journal. 42 (8): 944-7. doi:10.1111/j.1445-5994.2012.02856.x - Pubmed
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6. Säflund M, Sjöstrand C, Sveinsson O. The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL). (2018) Lakartidningen. Pubmed
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7. Yilmaz A, Kaleagasi H, Dogu O, Kara E, Ozge A. Abnormal MRI in a patient with 'headache with neurological deficits and CSF lymphocytosis (HaNDL)'. (2010) Cephalalgia : an international journal of headache. 30 (5): 615-9. doi:10.1111/j.1468-2982.2009.01950.x - Pubmed
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8. Al-Chalabi M, Hegde P, Asghar F et al. Transient Headache and Neurological Deficits with Cerebrospinal Fluid Lymphocytosis Syndrome: A Comprehensive Systematic Review of 93 Patients from 57 Studies. Cephalalgia. 2023;43(4):033310242311576. doi:10.1177/03331024231157694 - Pubmed
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9. Rodríguez-López C, Garzo Caldas N, Uriarte Pérez de Urabayen D et al. A New MR Radiological Sign in HaNDL Syndrome. A Case Report. J Clin Neurosci. 2019;61:274-6. doi:10.1016/j.jocn.2018.11.018 - Pubmed
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