title: HaNDL syndrome: Correlation between focal deficits topography and EEG or SPECT abnormalities in a series of 5 new cases.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Servicio de Neurofisiología, Hospital Clínico Universitario de Valladolid.
authors.forename: J
authors.initials: J
authors.lastname: Barón
authors.affiliation: Servicio de Neurología, Hospital Clínico Universitario de Valladolid.
authors.forename: P
authors.initials: P
authors.lastname: Mulero
authors.affiliation: Servicio de Neurología, Hospital Clínico Universitario de Valladolid.
authors.forename: M I
authors.initials: MI
authors.lastname: Pedraza
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid.
authors.forename: C
authors.initials: C
authors.lastname: Gamazo
authors.affiliation: Servicio de Neurología, Hospital Clínico Universitario de Valladolid.
authors.forename: C
authors.initials: C
authors.lastname: de la Cruz
authors.affiliation: Servicio de Neurología, Hospital Clínico Universitario de Valladolid.
authors.forename: M
authors.initials: M
authors.lastname: Ruiz
authors.affiliation: Servicio de Neurofisiología, Hospital Clínico Universitario de Valladolid.
authors.forename: M
authors.initials: M
authors.lastname: Ayuso
authors.affiliation: Servicio de Neurofisiología, Hospital Clínico Universitario de Valladolid.
authors.forename: M C
authors.initials: MC
authors.lastname: Cebrián
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid.
authors.forename: P
authors.initials: P
authors.lastname: García-Talavera
authors.affiliation: Servicio de Neurología, Hospital Clínico Universitario de Valladolid.
authors.forename: J
authors.initials: J
authors.lastname: Marco
authors.affiliation: Servicio de Neurología, Hospital Clínico Universitario de Valladolid. Electronic address: gueneurol@gmail.com.
authors.forename: A L
authors.initials: AL
authors.lastname: Guerrero
mesh_terms: D000328:Adult; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D007964:Leukocytosis / Q000134:cerebrospinal fluid; D008218:Lymphocytosis / Q000134:cerebrospinal fluid / Q000150:complications*; D008297:Male; D008881:Migraine Disorders / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D009422:Nervous System Diseases / Q000175:diagnosis*; D012189:Retrospective Studies; D013030:Spain; D013577:Syndrome; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
keywords: Cefalea; Electroencefalograma; Electroencephalogram; HaNDL; Headache; LCR pleocytosis; Pleocitosis líquido cefalorraquídeo; Single photon emission computed tomography; Tomografía por emisión de fotón único