Agraphia: Presenting Feature of Syndrome of Transient Headache and Neurological Deficits With Cerebrospinal Fluid Lymphocytosis (HaNDL)

Salazar-Orellana, Jaime Leonardo I; Prado-Miranda, Gala; Maldonado-Ortiz, Amelia

doi:10.7759/cureus.13178

Cited by 3 publications

(4 citation statements)

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“…Forty-three articles were further excluded, as they had incomplete information on demographics or were difficult to comprehend. This left us with a total of 57 case reports and case series (Figure 1) (1,5–7,10,13,17–68).…”

Section: Selection Of Studies and Data Collectionmentioning

confidence: 99%

“…Follow-up CSF analysis was reported in 23 cases, with universal reduction of lymphocytic pleocytosis associated with resolution of transient neurologic deficits. The degree of reduction varied significantly, as did the time period over which the reduction occurred (1,3,(17)(18)(19)(20)23,24,26,29,31,34,35,43,(47)(48)(49)53,56,(60)(61)(62)65).…”

Section: Csf Characteristicsmentioning

confidence: 99%

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Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis syndrome: A comprehensive systematic review of 93 patients from 57 studies

et al. 2023

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Background Headache with neurologic deficits and cerebrospinal fluid lymphocytosis, previously also termed pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis, is a self-limiting syndrome characterized by moderate to severe headache associated with focal neurological deficits occurring in the context of lymphocytosis in the cerebrospinal fluid. As a consequence of its rarity, data regarding headache with neurologic deficits and cerebrospinal fluid lymphocytosis is sparse. Therefore, we conducted this review to analyze data related to 93 patients of headache with neurologic deficits and cerebrospinal fluid lymphocytosis, to characterize their demographics, clinical manifestations, investigations and treatment options. Methods We performed a systematic review of cases reported through PubMed and Google scholar database, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Keywords used were ‘Headache with Neurologic Deficits and cerebrospinal fluid lymphocytosis’, ‘Headache with neurologic deficits and cerebrospinal fluid lymphocytosis syndrome’. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Results We analyzed a total of 93 cases of headache with neurologic deficits and cerebrospinal fluid lymphocytosis with a mean age of 28.8 years at onset. Seventy patients (75.2%) were adults, while 23 (24.7%) belonged to the pediatric age group. Comparing these groups, mean age at onset was 32.5 years and 14.3 years, respectively. The average duration of follow-up was 11.08 months. Thirty percent of patients experienced relapsing episodes of headache with neurologic deficits and cerebrospinal fluid lymphocytosis symptoms. The most common type of headache reported was unilateral severe throbbing episodic headache. Other associated symptoms included sensory deficit (60%) and motor deficits (54.8%). The least common symptoms were nystagmus and agraphia, which were reported in one patient each. Antiviral agents were a common treatment option in the acute phase (n = 23 patients [23.6%]), while Flunarizine was the most commonly used agent in the chronic setting (n = 3 patients [3.2%]). While most of the patients had normal brain magnetic resonance imaging, 20 patients had magnetic resonance imaging abnormalities, including (but not limited to) non-specific white matter lesions (eight patients) and meningeal enhancement (six patients). The most common electroencephalographic findings included diffuse and focal slowing. The mean cerebrospinal fluid opening-pressure was 240.5 mmH2O. Cerebrospinal fluid protein was elevated in 59 (63.4%) patients, with a mean value of 114 mg/dL. Two patients in our cohort were found to have cerebrospinal fluid oligoclonal bands. Conclusion Headache with neurologic deficits and cerebrospinal fluid lymphocytosis tends to affect young individuals with a slight male predominance. Unilateral severe throbbing episodic headache with associated hemi-paresthesia and hemiparesis were the most common symptoms based on our review. Elevated cerebrospinal fluid opening-pressure can be seen in headache with neurologic deficits and cerebrospinal fluid lymphocytosis syndrome. Early recognition of the syndrome is paramount. Antivirals were found to be among the most widely used treatments in the acute setting. Magnetic resonance imaging of the brain is mostly normal. Diffuse and focal slowing were among the most common electroencephalographic findings. Cerebral flow abnormalities on perfusion scans are not uncommon in headache with neurologic deficits and cerebrospinal fluid lymphocytosis. Prospective studies with a larger sample size are needed to validate our findings and guide the clinical care of these patients.

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Section: Selection Of Studies and Data Collectionmentioning

confidence: 99%

Section: Csf Characteristicsmentioning

confidence: 99%

Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis syndrome: A comprehensive systematic review of 93 patients from 57 studies

et al. 2023

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“…Häufig manifestieren sich sensomotorische Hemisyndrome sowie aphasische Symptome (Hemiparästhesie 75 %, Dysphasie 66 %, Hemiparese > 50 %, visuelle Positivsymptome < 20 %; [ 1 , 22 ]). Seltenere Manifestationsformen wie Agrafie und choreatiforme Bewegungsstörungen sind jedoch auch beschrieben [ 4 , 5 ].…”

Section: Verlaufunclassified

“…Methylprednisolonapplikation [ 5 , 19 ]. Andere gaben ein rasches Ansprechen auf Ibuprofen an [ 4 ]. Ob es sich hierbei evtl.…”

Section: Verlaufunclassified

Rezidivierende Kopfschmerzattacken mit wechselnden neurologischen Symptomen und Liquorpleozytose

2022

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Acute confusional state in HaNDL syndrome

et al. 2023

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Agraphia: Presenting Feature of Syndrome of Transient Headache and Neurological Deficits With Cerebrospinal Fluid Lymphocytosis (HaNDL)

Abstract: Salazar-Orellana et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 3 publications

References 13 publications

Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis syndrome: A comprehensive systematic review of 93 patients from 57 studies

Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis syndrome: A comprehensive systematic review of 93 patients from 57 studies

Rezidivierende Kopfschmerzattacken mit wechselnden neurologischen Symptomen und Liquorpleozytose

Acute confusional state in HaNDL syndrome

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