Confusional State in HaNDL Syndrome: Case Report and Literature Review

Nelson, Sarah E.

doi:10.1155/2013/317685

Cited by 22 publications

(14 citation statements)

References 25 publications

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“…Although diverse clinical presentations of neurologic deficits are described, involuntary movements have not been reported. Gómez-Aranda presented 50 cases and reported that the most common neurologic deficit was sensory symptom (78% of episodes), followed by aphasia (66%), motor symptom (56%) and visual symptom (12%).2 The uncommon presentations such as confusional state, amnesia and cranial neuropathy have also been described 3–5. The transient neurologic deficits could occur before or during the headache.2 For our patient, the chorea occurred during the headache, while sensory and weakness occurred before the headache.…”

Section: Discussionmentioning

confidence: 99%

<p>Chorea and the effectiveness of steroids in a patient with the syndrome of transient headache with neurologic deficits and cerebrospinal fluid lymphocytosis: a case report</p>

Zhao¹,

Wang²,

Fang³

et al. 2019

JPR

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Background The clinical manifestations of the transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome are variable, and involuntary movements have not been reported. The etiology and treatment of the syndrome are not entirely clarified. Case A 25-year-old female presented with recurrent transient headache, involuntary movements (left upper extremity chorea) and paralysis. Lumbar punctures showed intracranial hypertension and cerebrospinal fluid pleocytosis. Symptoms and intracranial hypertension were relieved after administration of steroids. Discussion/conclusion Chorea may also present in the HaNDL syndrome. Steroids might relieve the symptoms of the HaNDL syndrome, which indicates the possible treatment strategy for HaNDL and supports the infectious or postinfectious autoimmune etiology hypothesis.

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Section: Discussionmentioning

confidence: 99%

<p>Chorea and the effectiveness of steroids in a patient with the syndrome of transient headache with neurologic deficits and cerebrospinal fluid lymphocytosis: a case report</p>

Zhao¹,

Wang²,

Fang³

et al. 2019

JPR

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“…Etiology of HaNDL is not yet fully understood. Most studies suggest infectious, vascular and autoimmune mechanisms [5,6]. Currently, the main hypothesis is that this process is secondary to an activation of the immune system due to an infectious/inflammatory process, which activates the trigeminovascular system, leading to the development of focal neurological symptoms by a mechanism similar to the neuronal spreading depression seen in migraines with aura [7,8].…”

Section: Discussionmentioning

confidence: 99%

How to HaNDL This Case?

et al. 2016

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Headache and neurological deficits with cerebrospinal fluid (CSF) lymphocytosis (HaNDL) is a self-limited, benign neurological entity that may constitute a diagnosis dilemma since it can mimic a variety of conditions including aseptic meningitis, meningoencephalitis, migraine with aura and stroke. We report a case of a 31-year-old Caucasian man admitted at the emergency department for sudden onset of dysarthria and paresthesias in the right upper limb, after 2 weeks of complaints of headache associated with mild nausea. After extensive blood investigation, CSF study, electroencephalogram and neuroimaging, central nervous system infections, autoimmune and vascular diseases were excluded. CSF study revealed lymphocytic pleocytosis, normal glucose and slightly elevated protein concentration. Magnetic resonance imaging (MRI) showed a diffuse leptomeningeal enhancement, a decreased and delayed perfusion to the entire left hemisphere. The patient improved with supportive and symptomatic management. Two days after discharge, he developed a similar clinical picture and recovered completely 30 minutes after admission. His repeated lumbar puncture (LP) showed progressive improvement as expected due to the clinical resolution and MRI did not reveal any of the previous changes. Given the presentation (clinical picture, imaging and CSF studies), the subsequent similar and self-limited episode and having excluded other causes, a final diagnosis of HaNDL was made. HaN-DL is one of the most frequent stroke mimics and probably not as rare as commonly thought. It has a good prognosis since this monophasic, self-limiting condition runs its course usually within a few months from onset, without any neurological sequelae.

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“…65 HaNDL syndrome is a benign and self-limited disorder whose presentation can be protean, ranging from focal weakness 68 to altered mental status, and is classified as ICHD 7.3.5. 69 The SMART syndrome is an idiopathic disorder that is often found in patients treated with focal brain radiation for brain tumors and who develop transient headaches and focal neurological deficits about 2À10 years after radiation therapy. 67 …”

Section: The Diagnostic Challengementioning

confidence: 99%