The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis mimicking acute ischemic stroke.
Headache with neurologic deficits and cerebrospinal fluid lymphocytosis is a benign condition with a transient ischemic attack-like presentation. We present a case of a 22-year-old man with episodes of right-sided weakness, global dysphasia, and right-sided homonymous hemianopsia associated with frequent vomiting. Systemic thrombolytic therapy was considered. A subsequent magnetic resonance image with diffusion-weighted images revealed normal findings. A diagnosis of headache with neurologic deficits and cerebrospinal fluid lymphocytosis was made based mainly on clinical symptoms and cerebrospinal fluid analysis. With the current pressure on "door-to-needle" time for thrombolysis, it is important to keep an open eye to stroke mimics and exclude them if possible. We, therefore, strongly advise considering noninvasive magnetic resonance diffusion-weighted imaging in patients with unusual presentations (e.g., the vomiting in our patient) before thrombolysis.
Ariës
Marcel J H
MJ
Department of Neurology, University Medical Centre Groningen, University of Groningen, The Netherlands. m.j.h.aries@neuro.umcg.nl
van Oostrom
Joost C H
JC
de Keyser
Jacques
J
D000328:Adult; D001037:Aphasia / Q000209:etiology; D002545:Brain Ischemia / Q000175:diagnosis*; D002555:Cerebrospinal Fluid / Q000166:cytology; D000075202:Contraindications; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D006423:Hemianopsia / Q000209:etiology; D006801:Humans; D008218:Lymphocytosis / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D008297:Male; D020326:Migraine without Aura / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D010291:Paresis / Q000209:etiology; D013577:Syndrome; D015912:Thrombolytic Therapy; D014839:Vomiting / Q000209:etiology*