title: Syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis presenting as acute neurological emergencies.
abstract: Background The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) is a self-limited benign disorder of unclear pathogenesis, with diverse clinical manifestations. Cases We report two unusual presentations of this entity. The first case developed a catastrophic picture, characterized by acute elevation of intracranial pressure, necessitating emergency life support. The second case presented with hyperacute-onset mixed aphasia and facial droop, masquerading as acute ischemia of the middle cerebral artery territory. Both patients made full recoveries. Conclusion The possibility of HaNDL should be considered in individuals presenting with unusual patterns of headaches and transient neurological symptoms. Our report will expand the spectrum of this disorder, which will help physicians not only to recognize the unusual manifestations of this rare disorder, but also consider potential therapeutic interventions.
authors.affiliation: 1 Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA.|2 Division of Neurocritical Care, Department of Neurology, Duke University Hospital, Durham, NC, USA.
authors.forename: M-Alain
authors.initials: MA
authors.lastname: Babi
authors.affiliation: 1 Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA.|3 Department of Neurology, St-Peter's Hospital, Albany, NY, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Applebee
authors.affiliation: 1 Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Shapiro
authors.affiliation: 1 Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Waqar
authors.initials: W
authors.lastname: Waheed
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008218:Lymphocytosis / Q000134:cerebrospinal fluid*; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology; D013577:Syndrome
keywords: CSF pleocytosis; HaNDL; carotid dissection; cervicocephalic artery dissection; cortical spreading depolarization; critical care/emergency neurology; headache; migraine; neurological deficits