Altered conscious state as a presentation of the syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) in a paediatric patient

Armiento, Raffaela; Kornberg, Andrew J.

doi:10.1111/jpc.13199

Cited by 11 publications

(9 citation statements)

References 8 publications

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“…Twenty-three of these cases fulfilled all the diagnostic criteria for HaNDL syndrome and were classified as definite. 2 –20 The remaining 7 fulfilled all but 1 of the criteria (infectious organism detected in 2, cerebrospinal fluid lymphocyte count less than 15 cells/µL in 1, syndrome duration longer than 3 months in 2, episode duration less than 4 hours in 2) and were classified as probable. 8,16,21 –24 At least 7 cases from 4 articles were excluded from analysis as insufficient clinical data was reported to confirm the diagnosis or more than 1 diagnostic criterion were not met.…”

Section: Methodsmentioning

confidence: 99%

“…Several patients had fever prior to or during episodes of HaNDL syndrome, though no infectious etiology was identified in these cases. 3,5,7,10,14,17,19 Of the 18 patients who had an opening pressure documented, 72% were elevated (28 mmHg), with papilledema noted in more than three-quarters of these (Table 1). 5,7,23,29 Cerebrospinal fluid lymphocytosis averaged 95%, with 1 outlier of 67%.…”

Section: Literaturementioning

confidence: 99%

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HaNDL Syndrome: Case Report and Literature Review

Armstrong‐Javors

Krishnamoorthy

2018

J Child Neurol

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Headache and Neurologic Deficits with cerebrospinal fluid Lymphocytosis (HaNDL) syndrome is a rare stroke mimicker characterized by moderate to severe headache temporally associated with transient neurologic deficits, typically hemiparesis, hemisensory disturbance, and/or aphasia. Cerebrospinal fluid studies reveal a lymphocytosis and elevated protein. Episodes recur over a period no longer than 3 months. Here we describe the case of a 16-year-old boy who presented with 3 episodes of selfresolving neurologic deficits, papilledema on fundoscopic examination, and leptomeningeal enhancement on magnetic resonance imaging (MRI). We additionally review the 30 previously reported pediatric cases of HaNDL syndrome, with a focus on possible etiologic and pathophysiologic mechanisms of disease. The reported case and literature review highlight the benign episodic nature of this likely underrecognized syndrome as well as the higher than expected frequency of abnormal neuroimaging findings.

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Section: Methodsmentioning

confidence: 99%

Section: Literaturementioning

confidence: 99%

HaNDL Syndrome: Case Report and Literature Review

Armstrong‐Javors

Krishnamoorthy

2018

J Child Neurol

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“…We described three pediatric/adolescent patients fulfilling the diagnostic criteria for HaNDL syndrome. Presentation during childhood and adolescence is rare, with only five other cases in the literature (Table ) …”

Section: Discussionmentioning

confidence: 99%

Syndrome of Transient Headache and Neurologic Deficits With Cerebrospinal Fluid Lymphocitosis Should Be Considered in Children Presenting With Acute Confusional State

et al. 2017

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Presentation during childhood and adolescence is rare; the majority of pediatric cases presented with altered consciousness, which is infrequent in HaNDL. This may suggest that in childhood this symptom might be more common than in adults. All three patients presented with increased intracranial pressure and papilledema, thus suggesting that these aspects should be investigated in all patients presenting with this clinical pattern. Finally, all our patients began to suffer from migraine. This feature, together with the benign course of the disease, could favor the hypothesis of a migrainous pathophysiology of this syndrome, although this remains a speculative.

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“…However, some case reports are observed in adolescents and childhood [12,13]. The etiopathogenesis of HaNDL is poorly understood.…”

Section: Discussionmentioning

confidence: 99%

Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (Handl Syndrome): A case report

et al. 2017

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The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL) is a rare entity. This disease has been related with migrainous headaches. It is a benign disorder, self-limited, and characterized by fluctuating neurological symptoms and cerebrospinal fluid (CSF) lymphocytosis. A small proportion of patients develop intracranial hypertension as a consequence of the illness. Confusional state may be also observed.We describe a case of a 29 years old man with acute onset of headache, dysthermia sensation, vomits, aphasia, and difficulty to perform daily activities such as unlocking the mobile phone. Blood tests as well as computed tomography (CT) and magnetic resonance imaging (MRI) were normal. Cerebroespinal fluid analysis revealed a lymphocytic pleocytosis (47 cells/µl, 100% lymphocytes). Electroencephalogram showed moderate slow rhythm in the left hemisphere, with frontotemporal predominance, and without epileptiform activity. With the diagnosis of HaNDL syndrome the patient was accepted in the Department of Neurology and discharged asymptomatic without treatment.

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Altered conscious state as a presentation of the syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) in a paediatric patient

Cited by 11 publications

References 8 publications

HaNDL Syndrome: Case Report and Literature Review

HaNDL Syndrome: Case Report and Literature Review

Syndrome of Transient Headache and Neurologic Deficits With Cerebrospinal Fluid Lymphocitosis Should Be Considered in Children Presenting With Acute Confusional State

Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (Handl Syndrome): A case report

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