Getting a handle on complicated migraine.

Area of Science:

• Neurology
• Neuroimmunology

Background:

• The syndrome of Headache and Neurological Deficits with CSF Lymphocytosis (HaNDL) is a rare, transient neurological condition.
• Differential diagnosis for HaNDL is crucial due to its varied presentation and potential for mimicry of more severe neurological disorders.

Observation:

• A 45-year-old male presented with acute onset headache and transient neurological deficits.
• Initial neuroimaging, including cerebral angiography, revealed no abnormalities.
• Cerebrospinal fluid (CSF) analysis demonstrated elevated protein levels and lymphocytic pleocytosis.

Findings:

• The patient's clinical presentation and CSF findings, after exclusion of other causes, led to the diagnosis of HaNDL.
• The syndrome was transient, with neurological deficits resolving over time.

Implications:

• This case highlights the importance of considering HaNDL in patients presenting with headache and neurological deficits, particularly when CSF shows lymphocytosis and protein elevation.
• Prompt diagnosis and treatment with anti-inflammatory agents like naproxen sodium can lead to excellent patient outcomes.
• Further research into the pathophysiology of HaNDL may reveal underlying mechanisms contributing to transient neurological dysfunction.