Migrainous headache and CSF lymphocytosis-HaNDL syndrome: A case report

Abstract

A 24-year old female patient presented to the emergency unit with a pressure-like pain in the left frontal region, nausea, vomiting and phonophobia. She reported that half-an hour after the headache started she felt a numbness in the right hand which spreaded to the arm and face and later to the leg, a sligh weakness on the right side and slurring of the tongue and that these symptoms improved within 20 minutes. The headache lasted 4 hours. Personal history revealed no migraine or febrile illness. Neurologic examination was normal. Routine blood count and blood chemistry were normal except for a leucocytosis. CSF examination showed a lymphocytic pleocytosis of 55/mm3. Cranial MRI and brain contrast CT scan were normal. The EEG showed a moderate slowing of the background activity. CSF examination was repeated after 5 days and showed that the lymphocyte count had increased to 220/mm3 and an elevated protein count of 64 mg/dL. The slowing of the background activity was less pronounced on repeat EEG's. Other conditions which may have caused a similar clinical picture like Mollaret's meningit is, granulomatous or neoplastic meningitis, Lyme disease, neurobrucellosis, neurosiphyllis, migraine with aura or hemiplegic migraine were ruled out by appropriate laboratory investigation. The clinical picture was diagnosed as Headache with Neurological Deficits and CSF Lymphocytosis (HaNDL) syndrome. In this case report we present this case with HaNDL syndrome and aim to present a short review of this rare headache syndrome.