Selective aphasia and focal hypoperfusion in a bilingual patient with HaNDL syndrome

The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) is a rare disease (1) characterized by a benign, self-limited headache syndrome accompanied by neurological deficits (isolated aphasia can be seen in nearly 22% of these patients (2)). Differential diagnosis between acute ischemic stroke and HaNDL syndrome has to be made in order to decide whether to perform a lumbar puncture or start reperfusion treatment early. CT perfusion have proved to be useful for differential diagnosis (3). We present a case of a HaNDL patient referred to the Emergency Department as a stroke in the context of acute onset of selective aphasia (Spanish) in a bilingual patient (French-Spanish). Urgent CT perfusion during the episode revealed increased mean transit time (MTT) with normal Cerebral Blood Flow (CBF) in posterior language areas. The case provides information on a HaNDL attack and its pathophysiology with hemodynamic changes in the acute period during the episode and the benign condition of the illness.