The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL): a description of three patients
https://doi.org/10.14412/2074-2711-2020-4-65-72
Abstract
Three clinical cases of the syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) are first described in Russian literature. The patients were young (aged 30–35 years), had symptoms characteristic of the prodromal period of infections. In all the patients, the disease started with intense headache, followed by focal neurological symptoms: aphasia and hemihypesthesia in all cases and confusion with psychomotor agitation in two cases. All the three patients showed spontaneous recovery within 2–3 days. Perfusion computed tomography, magnetic resonance imaging, and electroencephalography are compared in one of the cases. The differential diagnosis of HaNDL with acute cerebrovascular accident, herpetic encephalitis, epilepsy, and migraine is discussed.
About the Authors
A. A. Kulesh
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia; City Clinical Hospital Four
Russian Federation
Russian Federation
Aleksey Aleksandrovich Kulesh
26, Petropavlovskaya St., Perm 614990
2, Kim St., Perm 614107
N. L. Starikova
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia; City Clinical Hospital Four
Russian Federation
26, Petropavlovskaya St., Perm 614990
2, Kim St., Perm 614107
Russian Federation
26, Petropavlovskaya St., Perm 614990
2, Kim St., Perm 614107
V. E. Drobakha
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia; City Clinical Hospital Four
Russian Federation
26, Petropavlovskaya St., Perm 614990
2, Kim St., Perm 614107
Russian Federation
26, Petropavlovskaya St., Perm 614990
2, Kim St., Perm 614107
L. Yu. Brokhin
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia; City Clinical Hospital Four
Russian Federation
26, Petropavlovskaya St., Perm 614990
2, Kim St., Perm 614107
Russian Federation
26, Petropavlovskaya St., Perm 614990
2, Kim St., Perm 614107
A. S. Chubarov
Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia; City Clinical Hospital Four
Russian Federation
26, Petropavlovskaya St., Perm 614990
2, Kim St., Perm 614107
Russian Federation
26, Petropavlovskaya St., Perm 614990
2, Kim St., Perm 614107
References
1. Quintas S, Lopez Ruiz R, Trillo S, et al. Clinical, imaging and electroencephalographic characterization of three cases of HaNDL syndrome. Cephalalgia. 2018 Jun;38(7):1402-6. doi: 10.1177/0333102417735846
2. Ferrante E, Prone V. Possible clinical marker of first attack of HaNDL syndrome (strokelike mimics) in emergency room: a case report. Neurol Sci. 2018 Nov;39(11):2003-5. doi: 10.1007/s10072-018-3517-9
3. Bartleson JD, Swanson JW, Whisnant JP. A migrainous syndrome with cerebrospinal fluid pleocytosis. Neurology. 1981 Oct;31(10):1257-62. doi: 10.1212/wnl.31.10.1257
4. Berg MJ, Williams LS. The transient syndrome of headache with neurologic deficits and CSF lymphocytosis. Neurology. 1995 Sep;45(9):1648-54. doi: 10.1212/wnl.45.9.1648
5. Gomez-Aranda F, Canadillas F, MartiMasso JF, et al. Pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis. A report of 50 cases. Brain. 1997 Jul;120 (Pt 7):1105-13. doi: 10.1093/brain/120.7.1105
6. Babi MA, Applebee A, Shapiro R, et al. Syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis presenting as acute neurological emergencies. Cephalalgia. 2017 Mar;37(3):284-9. doi: 10.1177/0333102416642733
7. The International Classification of Headache Disorders, 3 rd edition. Cephalalgia. 2018 Jan;38(1):1-211. doi: 10.1177/0333102417738202
8. Pascual J, Valle N. Pseudomigraine with lymphocytic pleocytosis. Curr Pain Headache Rep. 2003 Jun;7(3):224-8. doi: 10.1007/s11916003-0077-2
9. Stelten BM, Venhovens J, van der Velden LB, et al. Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL): A case report with serial electroencephalography (EEG) recordings. Is there an association with human herpes virus type 7 (HHV-7) infection? Cephalalgia. 2016 Nov;36(13):1296-301 doi: 10.1177/0333102415618616
10. Frediani F, Bussone G. Confusional state as first symptom of HaNDL syndrome. Neurol Sci. 2015 May;36 Suppl 1:71-4. doi: 10.1007/s10072-015-2194-1
11. Chapman KM, Szczygielski BI, Toth C, et al. Pseudomigraine with lymphocytic pleocytosis: a calcium channelopathy? Clinical description of 10 cases and genetic analysis of the familial hemiplegic migraine gene CACNA1A. Headache 2003 Sep;43(8):892-5. doi: 10.1046/j.1526-4610.2003.03168.x
12. Apetse K, Breynaert L, Butaud C, et al. Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis associated with IgM antibodies to the Epstein-Barr virus viral capsid antigen. Case Rep Neurol Med. 2013;2013:975709. doi: 10.1155/2013/975709
13. Nelson S. Confusional state in HaNDL syndrome: case report and literature review. Case Rep Neurol Med. 2013;2013:317685. doi: 10.1155/2013/317685
14. Soto-Insuga V, Lopez-Villanueva L, Rodrigo M, et al. Confusion as a presentation symptom of pseudomigraine with pleocytosis in a paediatric patient. Ann Pediatr (Barc). 2014 Jun;80(6):394-8. doi: 10.1016/j.anpedi.2013.10.025
15. Lo Re M, di Sapio A, Malentacchi M, et al. Acute confusional state in HaNDL syndrome (transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis). Neurol Sci. 2015 Mar;36(3):477-8. doi: 10.1007/s10072-014-2017-9
16. Guillan M, DeFelipe-Mimbrera A, AlonsoCanovas A, et al. The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis mimicking an acute stroke. Eur J Neurol. 2016 Jul;23(7):1235-40. doi: 10.1111/ene.13008
17. Yilmaz A, Kaleagasi H, Dogu O, et al. Abnormal MRI in a patient with ‘headache with neurological deficits and CSF lymphocytosis (HaNDL)’. Cephalalgia. 2010 May;30(5):615-9. doi: 10.1111/j.1468-2982.2009.01950.x
18. Garcia-Esperon C, Carrera D, PratsSanchez L, et al. Focal leptomeningeal uptake, a new radiological finding in pseudomigraine with pleocytosis. Captacion leptomeningea focal, un nuevo hallazgo radiologico en la seudomigrana con pleocitosis. Neurologia. 2017 Jan–Feb;32(1):63-5. doi: 10.1016/j.nrl.2015.03.007
19. Rodriguez-Lopez C, Garzo Caldas N, Uriarte Perez de Urabayen D, et al. A new MR radiological sign in HaNDL syndrome. A case report. J Clin Neurosci. 2019 Mar;61:274-6. doi: 10.1016/j.jocn.2018.11.018
20. Fuentes B, Diez Tejedor E, Pascual J, et al. Cerebral blood flow changes in pseudomigraine with pleocytosis analyzed by single photon emission computed tomography. A spreading depression mechanism? Cephalalgia. 1998 Oct;18(8):570-3. doi: 10.1046/j.14682982.1998.1808570.x
21. Kappler J, Mohr S, Steinmetz H. Cerebral vasomotor changes in the transient syndrome of headache with neurologic deficits and CSF lymphocytosis (HaNDL). Headache. 1997 Sep;37(8):516-8. doi: 10.1046/j.15264610.1997.3708516.x
22. Tabeeva G, Azimova J, Skorobogatych K. Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL). J Neurol Stroke. 2018;8(3):147-9. doi: 10.15406/jnsk.2018.08.00299
23. Gnann JW Jr, Whitley RJ. Herpes simplex encephalitis: an update. Curr Infect Dis Rep. 2017 Mar;19(3):13. doi: 10.1007/s11908-017-0568-7
24. Rabinstein AA. Herpes virus encephalitis in adults: current knowledge and old myths. Neurol Clin. 2017;35(4):695-705. doi: 10.1016/j.ncl.2017.06.006
25. Steiner I, Budka H, Chaudhuri A, et al. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol. 2010 Aug;17(8):999-e57. doi: 10.1111/j.1468-1331.2010.02970.x
26. Adler AC, Kadimi S, Apaloo C, et al. Herpes simplex encephalitis with two false-negative cerebrospinal fluid PCR tests and review of negative PCR results in the clinical setting. Case Rep Neurol. 2011 May;3(2):172-8. doi: 10.1159/000330298
27. Bradshaw MJ, Venkatesan A. Herpes simplex virus-1 encephalitis in adults: pathophysiology, diagnosis, and management. Neurotherapeutics. 2016 Jul;13(3):493-508. doi: 10.1007/s13311-016-0433-7
28. Ryan L, Heed A, Foster J, et al. Acute kidney injury (AKI) associated with intravenous aciclovir in adults: Incidence and risk factors in clinical practice. Int J Infect Dis. 2018 Sep;74:97-9. doi: 10.1016/j.ijid.2018.07.002
29. Richelsen RKB, Jensen SB, Nielsen H. Incidence and predictors of intravenous acyclovir-induced nephrotoxicity. Eur J Clin Microbiol Infect Dis. 2018 Oct;37(10):1965-71. doi: 10.1007/s10096-018-3332-5
30. Lee EJ, Jang HN, Cho HS, et al. The incidence, risk factors, and clinical outcomes of acute kidney injury (staged using the RIFLE classification) associated with intravenous acyclovir administration. Ren Fail. 2018 Nov;40(1):687-92. doi: 10.1080/0886022X.2018.1487866
31. Tattevin P, Tchamgoue S, Belem A, et al. Aseptic meningitis. Rev Neurol (Paris). 2019 Sep–Oct;175(7-8):475-80. doi: 10.1016/j.neurol.2019.07.005
32. Amodio P, Montagnese S. Clinical neurophysiology of hepatic encephalopathy. J Clin Exp Hepatol. 2014;5:S60-S68. doi: 10.1016/j.jceh.2014.06.007
33. Barona J, Mulerob P, Pedrazab MI, et al. Sindrome HaNDL: correlacion entre la topografia del deficit neurologico y las alteraciones en electroencefalograma y SPECT en una serie de 5 nuevos casos. Neurologia. 2016 Jun;31(5):305-10. doi: 10.1016/j.nrl.2015.03.004. Epub 2015 May 11.
34. Fitzpatrick W, Lowry N. PLEDs: clinical correlates. Can J Neurol Sci. 2007 Nov;34(4):443-50. doi: 10.1017/S0317167100007332
35. Masuda T, Kimura N, Nakamura K, et al. A case of limbic encephalitis repeated aphasic status epilepticus with periodic lateralized epileptiform discharges. Rinsho Shinkeigaku. 2011 Feb;51(2):135-40. doi: 10.5692/clinicalneurol.51.135
36. Niedermeyer E. Alpha rhythms as physiological and abnormal phenomena. Int J Psychophysiol. 1997 Jun;26(1-3):31-49. doi: 10.1016/s0167-8760(97)00754-x
37. Nerobkova LN, Avakyan GG, Voronina TA. Klinicheskaya elektroentsefalografiya. Farmakoelektroentsefalografiya [Clinical electroencephalography. Pharmacoelectroencephalography]. Moscow: GEOTAR-Media; 2020. ISBN 978-59704-5371-1 (In Russ.).
38. Gentile S, Rainero I, Daniele D, et al. Reversible MRI abnormalities in a patient with recurrent status migrainosus. Cephalalgia. 2009 Jun;29(6):687-90. doi: 10.1111/j.14682982.2008.01803.x
39. Mulroy E, Yap J, Danesh-Meyer H, et al. Symptomatic intracranial hypertension during recovery from the syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HANDL). Pract Neurol. 2017 Apr;17(2):145-8. doi: 10.1136/practneurol-2016-001539
Review
For citations:
Kulesh A.A., Starikova N.L., Drobakha V.E., Brokhin L.Yu., Chubarov A.S. The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL): a description of three patients. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(4):65-72. https://doi.org/10.14412/2074-2711-2020-4-65-72
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