HaNDL Syndrome Presenting During Pregnancy: A Case Report and Review of the Literature

Abstract

Headache associated with neurological deficits and cerebrospinal fluid lymphocytosis (HaNDL) is a self-limited syndrome characterized by sudden-onset headache with a temporary neurological deficit and cerebrospinal fluid (CSF) lymphocytosis. We aimed to disscus a case of HaNDL syndrome presenting during pregnancy with relevant literature.

A 20-year-old female presented with a 5-day history of severe, bilateral throbbing headache accompanied by nausea, vomiting, and phonophobia. Approximately 2 days after the pain developed, she became acutely confused for less than 90 minutes. 2 days after this episode, she experienced again confusional state and left hemiparesis. There were no symptoms consistent with meningoencephalitis. She was pregnant and at 11 weeks gestation. A neurologic examination showed confusional state, bilateral papilledema, and mild left hemiparesis. The neuroradiological examination was normal. The cerebrospinal fluid revealed lymphocytic pleocytosis, mildly elevated protein, and increased opening pressure.

She recovered completely after 8 days.

The precise etiology of HaNDL is unknown, although an inflammatory or infectious origin and autoimmune factors have been proposed. Moreover, the risk factors and medical conditions associated with HaNDL are unknown. It is obviously difficult to determine whether the pregnancy was coincidental or associated in this case. We believe that comprehensive studies are needed to clarify the risk factors and medical conditions associated with HaNDL.