title: Confusional state as first symptom of HaNDL syndrome.
abstract: HaNDL (transient headache and neurological deficits with cerebrospinal fluid lymphocytosis) syndrome is an infrequent condition included at group 7 "headache attributed to non-vascular intracranial disorder" in the recent International Classification of Headache Disorders (ICHD-3), code 7.3.5. The description states "migraine-like headache episodes (typically 1-12) accompanied by neurological deficits including hemiparaesthesia, hemiparesis and/or dysphasia, but positive visual symptoms only uncommonly, lasting several hours. There is lymphocytic pleocytosis. The disorder resolves spontaneously within 3 months". In this description confusional state is not considered as a main symptom, even if in the literature this aspect is frequently reported. Here, we report the cases of two young boys presenting with confusional state as the main complaint. The possible pathogenesis of the different clinical presentation is discussed.
authors.affiliation: Neurological and Stroke Unit Division, Headache Center, S. Carlo Borromeo Hospital, Via Pio II 3, 20153, Milan, Italy, frediani.fabio@sancarlo.mi.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Frediani
authors.forename: Gennaro
authors.initials: G
authors.lastname: Bussone
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D002443:Ceftriaxone / Q000627:therapeutic use; D003221:Confusion / Q000188:drug therapy / Q000209:etiology*; D006261:Headache / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008218:Lymphocytosis / Q000134:cerebrospinal fluid / Q000150:complications* / Q000188:drug therapy; D008297:Male; D009422:Nervous System Diseases / Q000150:complications* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D002443:Ceftriaxone; D000212:Acyclovir