HaNDL Syndrome - A revisit with 3 case reports
Introduction: The syndrome of headache, neurological deficit and cerebrospinal fluid lymphocytosis(HaNDL) also known as pseudomigraine with CSF pleocytosis is an uncommon condition that may mimic complicated migraine and stroke.Accurate recognition of this neurological condition requires a high index of clinical suspicion.The etiology and the pathophysiology of this disorder is not well defined but thought to be due to a viral infection activated immune response causing an aseptic inflammation in the meningeal vascular system causing transient vascular headache and neurological symptoms(Gomez-Aranda F et al).Having made a diagnosis of this clinical entity called HaNDL Syndrome,further management and prognostication becomes easy and reassuring to patient and their carers.
Methods: We present 3 patients who fulfil the clinical diagnostic criteria which include at least one episode of transient neurological deficit accompanied or followed by migraine like severe headache,cerebrospinal fluid lymphocytosis and normal neuroimaging.
Results: All 3 patients presented with a flurry of headache predominant neurological events with csf lymphocytosis.MRI brain imaging was normal.No specific aetiological agent was detected on serological examination.All symptoms completely resolved within 2 months.No recurrence of symptoms at the end of 6 month follow up noted.
Conclusion: HaNDL is a well defined clinical entity.Appropriate and timely clinical recognition helps favourable prognostication reassuring patient and their carers.
Keywords: HaNDL syndrome, pseudomigraine with CSF pleocytosis, cerebrospinal fluid.
Reference: Gomez-Aranda F,Canadillas F,Marti-Masso JF,et al.Pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis.A report of 50 cases.Brain.1997;120:1105-1113.