A HaNDL CASE with PAPILLEDEMA MIMICING TRANSIENT ISCHEMIC ATTACK

Abstract

ÖzetBeyin omurilik sıvısı (BOS) lenfositozu ve geçici nörolojik bulguların eşlik ettiği baş ağrısı sendromu ('The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis: HaNDL') nadir görülen, iyi seyirli, kendini sınırlayan ve az tanınan bir sendromdur. Zengin nörolojik semptomatolojisi ile morbidite ve mortaliteye yol açan çok sayıda hastalığı taklit edebilen bu sendrom için, klinik şüphe ile yapılan BOS incelemesi tanısal değer taşır. Etiyopatogenezi tam olarak bilinmese de, otoimmünite ön planda düşünülmektedir. Bu yazıda, ilk klinik prezentasyonu geçici iskemik atağı taklit eden, geçici ve tekrarlayıcı nörolojik bulgular gösteren epizodları ve normal BOS basıncına eşlik eden papilödem bulgusu ile bir HaNDL olgusu tartışıldı, sendromun tanımı, klinik tablo ve epidemiyolojisi, etiyopatogenezi, ayırıcı tanısı ve tedavisi literatür eşliğinde gözden geçirildi.Anahtar sözcükler: HaNDL, inme taklidi; intravenöz trombolitik tedavi; lenfositik pleositoz; otoimmün hastalık. SummaryThe syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL), is a rare, benign, self-limiting syndrome that is not well known. Cerebrospinal fluid examination (CSF) on clinical suspicion has diagnostic value for this syndrome, which has a rich neurological symptomatology that can mimic many diseases causing mortality and morbidity. Although the ethiopathogenesis of this syndrome is not fully known, autoimmunity is thought to be in the foreground. Described in this article is a HaNDL case that on first clinic presentation appeared to be a transient ischemic attack (TIA) with temporary but recurring neurological findings and normal CSF pressure accompanied by papilledema. Clinical features, epidemiology, ethiopathogenesis, differential diagnosis, and treatment of this syndrome are reviewed according to the literature.

HaNDL with bilateral central venous occlusions

“…2 The heterogenous clinical presentations of HaNDL syndrome can mimic neurological conditions such as Open access stroke, transient ischaemic attack, migraine and encephalitis. [11][12][13][14][15] The diagnostic criteria of HaNDL as outlined by the International Headache Society are based on typical clinical features, association between CSF pleocytosis and headache, as well as the exclusion of secondary causes. 8 CSF examination reveals lymphocytosis in the range of 10 to 760 cell/mm 3 , protein elevation up to 250 mg/dL in 91% to 96% of cases and an elevated opening pressure in 56% to 73% of measured cases.…”