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Zhu K, Born DW, Dilli E. Secondary Headache: Current Update. Headache 2020; 60:2654-2664. [PMID: 33078413 DOI: 10.1111/head.13986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this paper is to review some of the causes of secondary headache particularly focusing on the subcategories of secondary headache in the International Classification of Headache Disorders, 3rd edition, the clinical features of these headaches, and their associated features and management. OVERVIEW Headache attributed to trauma or injury to the head and/or neck, headache attributed to cranial or cervical vascular disorder, headache attributed to non-vascular intracranial disorder, headache attributed to a substance or its withdrawal, headache attributed to infection, headache attributed to disorder of homeostasis, and headache or facial pain attributed to disorder of the cranium, neck, eye, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure are discussed in this paper. DISCUSSION Headache is a common symptom of multiple medical conditions. Although a minority of headache patients have a secondary basis for their headaches, it is important to identify clinical features of secondary headache disorders including both the headache and non-headache features of the condition, diagnose the secondary etiology correctly, and treat them appropriately.
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Affiliation(s)
- Kai Zhu
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Dawson W Born
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Esma Dilli
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
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2
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Fernández-Rodríguez P, Lojo-Ramírez JA, Medina Rodríguez M, Jiménez-Hoyuela García JM, García-Solís D. Differential diagnosis of HaNDL syndrome in a case report of a pediatric patient: The role of SPECT with 99mTc-HMPAO. eNeurologicalSci 2020; 19:100240. [PMID: 32368627 PMCID: PMC7184255 DOI: 10.1016/j.ensci.2020.100240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 11/21/2022] Open
Abstract
•HaNDL syndrome may be a condition probably underdiagnosed in pediatric age.•A differential diagnosis with viral, vascular or autoimmune etiology is necessary.•Epileptiform alterations in EEG could be possible in this infrequent syndrome.•99mTc-HMPAO SPECT provides a potential role in the differential diagnostic and management.
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Affiliation(s)
| | | | | | | | - David García-Solís
- Department of Nuclear Medicine, Virgen del Rocío University Hospital, Seville, Spain
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3
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Hidalgo de la Cruz M, Domínguez Rubio R, Luque Buzo E, Díaz Otero F, Vázquez Alén P, Orcajo Rincón J, Prieto Montalvo J, Contreras Chicote A, Grandas Pérez F. Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) in a patient with confusional symptoms, diffuse EEG abnormalities, and bilateral vasospasm in transcranial Doppler ultrasound: A case report and literature review. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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4
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García-Gómez F, de la Riva-Pérez P, Páramo D, Navarro-Mascarell G, Dinca-Avarvarei L, Calvo-Morón M. Diagnóstico de síndrome de HaNDL. Rev Esp Med Nucl Imagen Mol 2019; 38:332-334. [DOI: 10.1016/j.remn.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/03/2018] [Accepted: 11/05/2018] [Indexed: 11/26/2022]
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5
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Diagnosis of HaNDL syndrome. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Headache and Neurologic Deficits with cerebrospinal fluid Lymphocytosis (HaNDL) syndrome is a rare stroke mimicker characterized by moderate to severe headache temporally associated with transient neurologic deficits, typically hemiparesis, hemisensory disturbance, and/or aphasia. Cerebrospinal fluid studies reveal a lymphocytosis and elevated protein. Episodes recur over a period no longer than 3 months. Here we describe the case of a 16-year-old boy who presented with 3 episodes of self-resolving neurologic deficits, papilledema on fundoscopic examination, and leptomeningeal enhancement on magnetic resonance imaging (MRI). We additionally review the 30 previously reported pediatric cases of HaNDL syndrome, with a focus on possible etiologic and pathophysiologic mechanisms of disease. The reported case and literature review highlight the benign episodic nature of this likely underrecognized syndrome as well as the higher than expected frequency of abnormal neuroimaging findings.
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Affiliation(s)
- Amy Armstrong-Javors
- 1 Department of Pediatric Neurology, Massachusetts General Hospital, Boston, MA, USA
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7
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Hidalgo de la Cruz M, Domínguez Rubio R, Luque Buzo E, Díaz Otero F, Vázquez Alén P, Orcajo Rincón J, Prieto Montalvo J, Contreras Chicote A, Grandas Pérez F. Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) in a patient with confusional symptoms, diffuse EEG abnormalities, and bilateral vasospasm in transcranial Doppler ultrasound: A case report and literature review. Neurologia 2017; 34:536-542. [PMID: 28427768 DOI: 10.1016/j.nrl.2017.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/18/2017] [Accepted: 02/05/2017] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION HaNDL syndrome (transient headache and neurological deficits with cerebrospinal fluid lymphocytosis) is characterised by one or more episodes of headache and transient neurological deficits associated with cerebrospinal fluid lymphocytosis. To date, few cases of HaNDL manifesting with confusional symptoms have been described. Likewise, very few patients with HaNDL and confusional symptoms have been evaluated with transcranial Doppler ultrasound (TCD). TCD data from patients with focal involvement reveal changes consistent with vasomotor alterations. DEVELOPMENT We present the case of a 42-year-old man who experienced headache and confusional symptoms and displayed pleocytosis, diffuse slow activity on EEG, increased blood flow velocity in both middle cerebral arteries on TCD, and single-photon emission computed tomography (SPECT) findings suggestive of diffuse involvement, especially in the left hemisphere. CONCLUSIONS To our knowledge, this is the first description of a patient with HaNDL, confusional symptoms, diffuse slow activity on EEG, and increased blood flow velocity in TCD. Our findings suggest a relationship between cerebral vasomotor changes and the pathophysiology of HaNDL. TCD may be a useful tool for early diagnosis of HaNDL.
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Affiliation(s)
- M Hidalgo de la Cruz
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - R Domínguez Rubio
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - E Luque Buzo
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Díaz Otero
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Vázquez Alén
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Orcajo Rincón
- Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Prieto Montalvo
- Servicio de Neurofisiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Contreras Chicote
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Grandas Pérez
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Oberndorfer S, Wöber C, Nasel C, Asenbaum S, Lahrmann H, Fueger B, Grisold W. Familial Hemiplegic Migraine: Follow-up Findings of Diffusion-Weighted Magnetic Resonance Imaging (MRI), Perfusion-MRI and [99mTc] HMPAO-SPECT in a Patient with Prolonged Hemiplegic Aura. Cephalalgia 2016; 24:533-9. [PMID: 15196295 DOI: 10.1111/j.1468-2982.2003.00706.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Familial hemiplegic migraine (FHM) is a rare inherited autosomal dominant disorder. Migraine aura may last up to several weeks and then resolve without sequel. We report a 21-year-old male with FHM since the age of 3 years. Diffusion-weighted magnetic resonance imaging (DWI), perfusion-MR imaging (P-MRI) and [99mTc] hexamethyl-propyleneamine-oxime-single photon emission tomography (HMPAO-SPECT) were performed on day 2, when he was somnolent with right-sided hemiplegia, on day 9 when a mild hemiparesis was still present and on day 24 after recovery. The right central region showed normal findings in DWI, whereas P-MRI and SPECT revealed hyperperfusion on day 2, less marked on day 9, and normal findings on day 24. In conclusion, this case report indicates for the first time, by means of SPECT, P-MRI and DWI studies, that even extremely long-lasting migraine aura is not associated with cerebral ischaemia. Therefore, it supports the revised International Headache Society criteria where the term ‘persistent’ aura is proposed.
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Affiliation(s)
- S Oberndorfer
- Neurological Department, Kaiser-Franz-Josef-Spital, University of Vienna, Austria.
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9
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Fumal A, Vandenheede M, Coppola G, Di Clemente L, Jacquart J, Gérard P, de Noordhout AM, Schoenen J. The Syndrome of Transient Headache with Neurological Deficits and CSF Lymphocytosis (HaNDL): Electrophysiological Findings Suggesting a Migrainous Pathophysiology. Cephalalgia 2016; 25:754-8. [PMID: 16109060 DOI: 10.1111/j.1468-2982.2004.00945.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A Fumal
- Department of Neurology, University of Liege, Liege, Belgium
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10
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Barón J, Mulero P, Pedraza M, Gamazo C, de la Cruz C, Ruiz M, Ayuso M, Cebrián M, García-Talavera P, Marco J, Guerrero A. HaNDL syndrome: Correlation between focal deficits topography and EEG or SPECT abnormalities in a series of 5 new cases. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2015.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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11
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Valença MM, de Oliveira DA, Martins HADL. Alice in Wonderland Syndrome, Burning Mouth Syndrome, Cold Stimulus Headache, and HaNDL: Narrative Review. Headache 2015; 55:1233-48. [DOI: 10.1111/head.12688] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Marcelo M. Valença
- Neurology and Neurosurgery Unit, Department of Neuropsychiatry; Federal University of Pernambuco; Brazil
- Neurology and Neurosurgery Unit; Hospital Esperança; Brazil
| | - Daniella A. de Oliveira
- Neurology and Neurosurgery Unit, Department of Neuropsychiatry; Federal University of Pernambuco; Brazil
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12
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Barón J, Mulero P, Pedraza MI, Gamazo C, de la Cruz C, Ruiz M, Ayuso M, Cebrián MC, García-Talavera P, Marco J, Guerrero AL. HaNDL syndrome: Correlation between focal deficits topography and EEG or SPECT abnormalities in a series of 5 new cases. Neurologia 2015; 31:305-10. [PMID: 25976938 DOI: 10.1016/j.nrl.2015.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/11/2014] [Accepted: 03/05/2015] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) is characterised by migraine-like headache episodes accompanied by neurological deficits consisting of motor, sensory, or aphasic symptoms. Electroencephalogram (EEG) and single photon emission computed tomography (SPECT) may show focal abnormalities that correspond to the neurological deficits. We aim to evaluate the correlation between focal deficit topography and EEG or SPECT abnormalities in 5 new cases. PATIENTS We retrospectively reviewed patients attended in a tertiary hospital (January 2010-May 2014) and identified 5 patients (3 men, 2 women) with a mean age of 30.6 ± 7.7 (21-39) years. They presented 3.4 ± 2.6 episodes of headache (range, 2-8) of moderate to severe intensity and transient neurological deficits over a maximum of 5 weeks. Pleocytosis was detected in CSF in all cases (70 to 312 cells/mm3, 96.5-100% lymphocytes) with negative results from aetiological studies. RESULTS At least one EEG was performed in 4 patients and SPECT in 3 patients. Patient 1: 8 episodes; 4 left hemisphere, 3 right hemisphere, and 1 brainstem; 2 EEGs showing left temporal and bilateral temporal slowing; normal SPECT. Patient 2: 2 episodes, left hemisphere and right hemisphere; SPECT showed decreased left temporal blood flow. Patient 3: 3 left hemisphere deficits; EEG with bilateral frontal and temporal slowing. Patient 4: 2 episodes with right parieto-occipital topography and right frontal slowing in EEG. Patient 5: 2 episodes, right hemisphere and left hemisphere, EEG with right temporal slowing; normal SPECT. CONCLUSION The neurological deficits accompanying headache in HaNDL demonstrate marked clinical heterogeneity. SPECT abnormalities and most of all EEG abnormalities were not uncommon in our series and they did not always correlate to the topography of focal déficits.
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Affiliation(s)
- J Barón
- Servicio de Neurofisiología, Hospital Clínico Universitario de Valladolid
| | - P Mulero
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid
| | - M I Pedraza
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid
| | - C Gamazo
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid
| | - C de la Cruz
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid
| | - M Ruiz
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid
| | - M Ayuso
- Servicio de Neurofisiología, Hospital Clínico Universitario de Valladolid
| | - M C Cebrián
- Servicio de Neurofisiología, Hospital Clínico Universitario de Valladolid
| | - P García-Talavera
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid
| | - J Marco
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid
| | - A L Guerrero
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid.
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Soto-Insuga V, López-Villanueva L, Rodrigo M, Aroyo IM, Losada R, Soriano-Guillén L. Confusion as a presentation symptom of pseudomigraine with pleocytosis in a paediatric patient. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.anpede.2013.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Biçakci Ş, Kurtaran B, Over MF, Biçakci YK. Are the Comments on HaNDL Syndrome in the ICHD-II Sufficient? Noro Psikiyatr Ars 2014; 51:178-180. [PMID: 28360621 DOI: 10.4274/npa.y6858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 02/01/2013] [Indexed: 12/01/2022] Open
Abstract
A 33-year-old man was admitted to our emergency department for severe frontal headache followed by a state of consciousness disturbance and right-sided hemiparesis. No previous febrile disease, head trauma, vascular risk factor, and medication for any systemic disease were defined in his history. He had experienced a similar disorder three years ago and had recovered completely. Cerebrospinal fluid (CSF) analysis revealed pleocytosis and electroencephalography (EEG) showed diffuse slow wave activity. Hyperintense foci on T2 and FLAIR sequences representing bilateral cortical ischemia, prominent on the right hemisphere, were seen on MRI. Contrast-enhanced T1 images showed marked leptomeningeal thickening with enhancement. The patient was considered as having CSF lymphocytosis (HaNDL syndrome) due to temporary headache with neurologic deficit and CSF pleocytosis. Diagnostic criteria have been identified for this syndrome according to the International Classification of Headache Disorders, 2nd edition (ICHD-II). According to these criteria, neuroimaging should be normal. Positive neuroimaging findings and impairment of consciousness have been reported in a limited number of HaNDL cases so far. Diversity of neurological signs, duration and distinctness from migraine headache have been described in comment section under the diagnostic criteria. Comments are inadequate in this regard.
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Affiliation(s)
- Şebnem Biçakci
- Çukurova University Faculty of Medicine, Department of Neurology, Adana, Turkey
| | - Behice Kurtaran
- Çukurova University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey
| | | | - Yunus Kenan Biçakci
- Çukurova University Faculty of Medicine, Department of Radiology, Adana, Turkey
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Soto-Insuga V, López-Villanueva L, Rodrigo M, Mois Aroyo I, Losada R, Soriano-Guillén L. [Confusion as a presentation symptom of pseudomigraine with pleocytosis in a paediatric patient]. An Pediatr (Barc) 2013; 80:394-8. [PMID: 24286871 DOI: 10.1016/j.anpedi.2013.10.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/11/2013] [Accepted: 10/14/2013] [Indexed: 11/28/2022] Open
Abstract
Transient headache and neurological deficits with cerebrospinal fluid lymphocytic pleocytosis (Handl) syndrome is a rare condition of unknown origin that is characterized by episodes of severe headache, transient neurological deficits that recur over less than 3 months, and lymphocytic pleocytosis in CSF. We report the case of a 14 year-old girl who presented with headache and vomiting that lasted 4 days, later combined with a clinical presentation of confusion, with a decrease in the level of consciousness, aphasia, peripheral facial paralysis, ataxia and fever for 24 hours. CSF analysis showed pleocytosis (110 cells/ml) and proteinorrachia (87 mg/dl). Electroencephalogram in the acute time showed generalized slowing, and later a focal slowing in the left hemisphere. She suffered 7 episodes of migraine (severe headache and vomiting) in the following two months, remaining asymptomatic thereafter. This is the first pediatric case published in the literature that presents with an agitated and/or confused state. This condition must be considered in the differential diagnosis of patients with headache and acute altered level of consciousness, in order to avoid prolonged treatments or unnecessary invasive testing.
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Affiliation(s)
- V Soto-Insuga
- Servicio de Pediatría, Fundación Jiménez Díaz, Madrid, España.
| | | | - M Rodrigo
- Servicio de Pediatría, Fundación Jiménez Díaz, Madrid, España
| | - I Mois Aroyo
- Servicio de Pediatría, Fundación Jiménez Díaz, Madrid, España
| | - R Losada
- Servicio de Pediatría, Fundación Jiménez Díaz, Madrid, España
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Confusional State in HaNDL Syndrome: Case Report and Literature Review. Case Rep Neurol Med 2013; 2013:317685. [PMID: 23991343 PMCID: PMC3749557 DOI: 10.1155/2013/317685] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 07/18/2013] [Indexed: 11/18/2022] Open
Abstract
The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) is a self-limited condition. Confusional states are uncommonly reported as a clinical manifestation of this syndrome. Here, I report a 76-year-old female who presented with headache, confusion, and agitation with a mild CSF lymphocytosis. Other workup to determine the cause of her altered mental status was otherwise negative. The literature available in the English language on HaNDL syndrome is reviewed, including its history, pathophysiology, possible associations with migraine and stroke, and previously reported cases of confusional states in this syndrome. While HaNDL syndrome has been a described entity since the 1980s, its pathophysiology has yet to be clearly defined.
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Filina T, Feja KN, Tolan RW. An adolescent with pseudomigraine, transient headache, neurological deficits, and lymphocytic pleocytosis (HaNDL Syndrome): case report and review of the literature. Clin Pediatr (Phila) 2013; 52:496-502. [PMID: 23559488 DOI: 10.1177/0009922813483358] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a 16-year-old adolescent with 2 episodes of focal neurological deficits, pseudomigrainous headache, and lymphocytic pleocytosis due to the syndrome of transient headache and neurological deficits with cerebrospinal fluid (CSF) lymphocytosis (HaNDL), also known as pseudomigraine with CSF pleocytosis. Review of the literature identifies 13 additional cases of HaNDL in the pediatric population. These cases are reviewed and evidence for possible etiopathogenesis is discussed. This syndrome may mimic much more common conditions such as complicated or hemiplegic migraine, aseptic meningitis, meningoencephalitis, or stroke. However, HaNDL differs from complicated or hemiplegic migraine and stroke since CSF pleocytosis is uniformly present. There are many infectious conditions that can present with neurological deficits, headache, and CSF pleocytosis, but the transient nature of the deficits and lack of a consistently identifiable infectious etiology despite extensive evaluations typify HaNDL. This clinical syndrome is underrecognized and underreported. HaNDL remains a diagnosis of exclusion.
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Affiliation(s)
- Tatiana Filina
- The Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ 08901, USA
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Parissis D, Ioannidis P, Balamoutsos G, Karacostas D. Confusional State in the Syndrome of HaNDL. Headache 2011; 51:1285-8. [DOI: 10.1111/j.1526-4610.2011.01884.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Gantenbein AR, Riederer F, Mathys J, Biethahn S, Gossrau G, Waldvogel D, Sándor PS. Confusional migraine is an adult as well as a childhood disease. Cephalalgia 2010; 31:206-12. [DOI: 10.1177/0333102410377361] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Acute confusional migraine (ACM) is considered a rare migraine variant primarily seen in children and adolescents. Patients and Methods: We present a series of eight adults and two adolescents suffering from migraine attacks associated with transient confusional states. Results: Eight patients reported two or more such attacks. One of them reported mild head trauma in the past. One patient reported mild head trauma as a possible trigger. Further investigations were unremarkable in all patients and did not suggest underlying structural abnormalities, epilepsy or cerebrovascular disease. In none of these patients did we find another cause to explain the observed phenomenon. Conclusions: Based on this series of patients, we suggest expanding the concept of confusional migraine from the paediatric population to adults. The temporal course of the confusion as well as the association with visual and other aura symptoms suggest cortical spreading depression as the underlying pathophysiology.
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Diener HC, Johansson U, Dodick DW. Headache attributed to non-vascular intracranial disorder. HANDBOOK OF CLINICAL NEUROLOGY 2010; 97:547-587. [PMID: 20816456 DOI: 10.1016/s0072-9752(10)97050-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This chapter deals with non-vascular intracranial disorders resulting in headache. Headache attributed to high or low cerebrospinal fluid pressure is separated into headache attributed to idiopathic intracranial hypertension (IIH), headache attributed to intracranial hypertension secondary to metabolic, toxic, or hormonal causes, headache attributed to intracranial hypertension secondary to hydrocephalus, post-dural puncture headache, cerebrospinal fluid (CSF) fistula headache, headache attributed to spontaneous (or idiopathic) low CSF pressure. Headache attributed to non-infectious inflammatory disease can be caused by neurosarcoidosis, aseptic (non-infectious) meningitis or lymphocytic hypophysitis. Headache attributed to intracranial neoplasm can be caused by increased intracranial pressure or hydrocephalus caused by neoplasm or attributed directly to neoplasm or carcinomatous meningitis. Other causes of headache include hypothalamic or pituitary hyper- or hyposecretion and intrathecal injection. Headache attributed to epileptic seizure is separated into hemicrania epileptica and post-seizure headache. Finally headache attributed to Chiari malformation type I (CM1) and the syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) are described.
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21
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Anagnostou E, Spengos K, Naoumis D, Paraskevas GP, Vassilopoulou S, Zis V, Vassilopoulos D. Lack of visual evoked potential habituation in the syndrome of HaNDL. J Neurol 2009; 256:1374-6. [PMID: 19363629 DOI: 10.1007/s00415-009-5127-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Revised: 02/26/2009] [Accepted: 03/19/2009] [Indexed: 10/20/2022]
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22
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Guilloton L, Didelot A, Gouillou A, Felten D, Drouet A. Syndrome de céphalées et déficits neurologiques transitoires avec lymphocytose du liquide céphalorachidien. Rev Med Interne 2008; 29:397-400. [DOI: 10.1016/j.revmed.2007.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 11/06/2007] [Indexed: 10/22/2022]
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Barroso B, Bertandeau E, Zerbib JL, Larribau E, Dakar A, Larrieu JM. [Pseudomigraine with transient neurological deficits and cerebrospinal fluid lymphocytosis]. Rev Neurol (Paris) 2005; 161:1102-5. [PMID: 16288175 DOI: 10.1016/s0035-3787(05)85177-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis is a rare syndrome resolving within less than 3 months. CASE REPORT A young 17-year-old woman without previous medical history was admitted to the hospital because of right motor weakness and language disturbances. The symptoms resolved in a few hours and were followed by severe left headaches with important vegetative signs. Several similar episodes were noted in the previous 10 days. Cranial MRI was normal. EEG showed important slowing of the cerebral electrogenesis. More than 250 lymphocytic cells were found at CSF analysis. Outcome was spontaneously favorable, without similar symptoms after 6-month follow-up. CONCLUSION Pseudomigraine with lymphocytic pleocytosis seems to be a particular syndrome of unknown origin. This is an elimination diagnosis, generally with a benign course.
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Affiliation(s)
- B Barroso
- Service de Neurologie, Centre Hospitalier François Mitterrand, Pau Université.
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Tada Y, Negoro K, Abe M, Ogasawara JI, Kawai M, Morimatsu M. A patient of migraine-like headache with amnesia, pleocytosis and transient hypoperfusion of cerebral blood flow. Intern Med 2005; 44:743-6. [PMID: 16093598 DOI: 10.2169/internalmedicine.44.743] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pseudomigraine with pleocytosis (PMP) is an uncommon disease in Japan. The diagnostic criteria include at least one episode of transient neurological deficit accompanied or followed by migraine-like severe headache, cerebrospinal fluid (CSF) lymphocytosis, and normal neuroimaging. Both the etiology and the pathophysiology of PMP is not yet well defined. We report a 40-year-old man with a PMP-like syndrome. He came to our clinic because of severe throbbing headache and amnesia, and the examination showed CSF lymphocytosis of 23/mm3, a transient decrease of cerebral blood flow in the left thalamus. All the symptoms were completely resolved within 2 months.
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Affiliation(s)
- Yukiko Tada
- Department of Neurology and Clinical Neuroscience, Yamaguchi University, Ube, Yamaguchi
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Chapman KM, Szczygielski BI, Toth C, Woolfenden A, Robinson G, Snutch TP, Spacey SD. Pseudomigraine with lymphocytic pleocytosis: a calcium channelopathy? Clinical description of 10 cases and genetic analysis of the familial hemiplegic migraine gene CACNA1A. Headache 2003; 43:892-5. [PMID: 12940811 DOI: 10.1046/j.1526-4610.2003.03168.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report the clinical findings of 10 patients diagnosed with pseudomigraine with lymphocytic pleocytosis and the results of mutational analysis of the CACNA1A gene in 8 of these patients. BACKGROUND Pseudomigraine with lymphocytic pleocytosis, also referred to as headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL), is characterized by episodic transient neurologic dysfunction associated with moderate to severe headache and cerebrospinal fluid lymphocytic pleocytosis. Episodes are recurrent and the condition is self-limiting. The etiology of this sporadic condition remains unknown, but the episodic nature and its ability to be triggered by angiography is somewhat reminiscent of the phenotypic features of familial hemiplegic migraine, a condition caused by mutations in the CACNA1A gene. DESIGN/METHODS Utilizing retrospective chart review, we describe the clinical features of pseudomigraine with lymphocytic pleocytosis in 10 patients. Whole blood was taken from 8 patients (2 were lost to follow-up) and used for DNA testing. The CACNA1A gene was screened for mutations using heteroduplex analysis and direct DNA sequencing. RESULTS Clinical features of pseudomigraine with lymphocytic pleocytosis included transient episodes of weakness, sensory and visual symptoms, aphasia, and confusion lasting minutes up to 4 hours. Sensory symptoms, typically affecting the face and arm, were the most common presentation. Localization of symptoms did not conform to vascular territories. Headache was typically throbbing and most often bilateral. Genetic analysis did not identify any mutations in the CACNA1A gene. CONCLUSIONS Similarities between familial hemiplegic migraine and pseudomigraine with lymphocytic pleocytosis include recurrent headache with reversible neurologic deficit, cerebrospinal fluid lymphocytic pleocytosis, and triggers such as angiography. Even so, heteroduplex analysis and DNA sequencing failed to identify any sporadic mutations or shared polymorphisms in the exons or the intron/exon boundaries of the CACNA1A gene. These results do not support a role of the CACNA1A gene in the etiology of pseudomigraine with lymphocytic pleocytosis.
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Affiliation(s)
- Kristine M Chapman
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
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Abstract
Pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis is a self-limited syndrome of unknown origin characterized by headache accompanied by transient neurologic symptoms and cerebrospinal fluid lymphocytosis. Patients with this condition are between 15 and 40 years of age. The syndrome is more frequent in men. The clinical picture encompasses one to 12 episodes of changing variable neurologic deficits accompanied by moderate to severe headache and occasional fever. These headaches are described as predominantly throbbing and bilateral with a variable duration (mean, 19 hours). The average duration of the transient neurologic deficit is 5 hours. Sensory (78% episodes), aphasic (66%), and motor (56%) disturbances are the most common. Migraine-like visual symptoms are relatively rare (18% episodes). Patients are asymptomatic between episodes and after the symptomatic period (duration > 3 months). Lymphocytic pleocytosis (10 to 760 cells mm(3)) and increased cerebrospinal fluid protein are found with negative bacteriologic, viral, fungal, and immunologic studies. Brain computed tomography and magnetic resonance imaging are normal, but an electroencephalogram frequently shows focal slowing over the symptomatic brain area. Single photon emission computed tomography reveals transient focal areas of decreased uptake consistent with the clinical symptoms. It is possible that pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis could result from an activation of the immune system secondary to a recent viral infection, which would produce antibodies against neuronal or vascular antigens. This autoimmune attack may induce an aseptic leptomeningeal vasculitis, accounting for the headache and the transient symptoms likely through a spreading depression-like mechanism.
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Affiliation(s)
- Julio Pascual
- Service of Neurology, University Hospital Marqués de Valdecilla (UC), 39008 Santander, Spain.
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Fleisher A, Kaplan PW. Headache with prolonged focal neurologic symptoms and cerebrospinal fluid pleocytosis: a case report. Headache 2002; 42:362-4. [PMID: 12047338 DOI: 10.1046/j.1526-4610.2002.02109.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Adam Fleisher
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Gekeler F, Holtmannspötter M, Straube A, Klopstock T. Diffusion-weighted magnetic resonance imaging during the aura of pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis. Headache 2002; 42:294-6. [PMID: 12010388 DOI: 10.1046/j.1526-4610.2002.02086.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A typical feature of pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis (PMP) is the long duration of aura symptoms. To determine if these prolonged auras cause early ischemic parenchymal changes, we performed diffusion-weighted magnetic resonance imaging during the aura of a patient with PMP and found no reduction of water diffusion.
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Affiliation(s)
- Florian Gekeler
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-Universität, Munich, Germany
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