Abstract Details

Title A Case of Headache Associated with Transient Neurologic Deficits and CSF Lymphocytosis Followed by Transient Ophthalmologic Symptoms

Topic Headache

Presentation(s) P01 - (-)

Poster/Presentation
Number 077

Objective

Background HaNDL is a benign, self-limited syndrome of unknown etiology combining migrainous headache, transient focal neurologic deficit and CSF lymphocytic pleocytosis. It is uncommon and may be misdiagnosed with transient ischemic attack or hemiplegic migraine.

Design/Methods Case report.

Results A 27-year-old male with no previous history of headache presented to emergency department with two transient episodes of right-sided weakness, numbness, and expressive aphasia followed by bifrontal pounding headache. The headache was combined with nausea, vomiting, and photophobia. On admission, physical findings revealed no signs of meningeal irritations, or focal neurologic deficits. Magnetic resonance imaging, magnetic resonance angiography, and magnetic resonance venography showed no ischemic, hemorrhagic processes, vascular stenosis or occlusion. Electroencephalography was normal. Cerebrospinal fluid(CSF) study revealed elevated intracranial pressure(ICP), elevated white cell counts of 99/mm3 with lymphocytic predominance (97%), elevated protein of 93 mg/dl. CSF bacterial and viral profiles were unremarkable. One week later, the patient presented with diplopia, bilateral 6th cranial nerves palsy with papilledema. CSF studies showed lymphocytic pleocytosis with mildly elevated ICP. His headache was treated with Topiramate and all symptoms were completely resolved within 2 weeks from the initial presentation.

Conclusions This report shows transient ophthalmologic symptoms can also present with transient focal weakness, numbness, and aphasia as neurologic manifestations of HaNDL. Although this syndrome is uncommon, it should be considered as a differential diagnosis when patients present with headache and varied transient neurologic deficits.

Authors/Disclosures
Sikawat Thanaviratananich, MD (Case Western Reserve University) PRESENTER	Dr. Thanaviratananich has nothing to disclose.
Bokkwan Jun, MD, PhD (NYNOS)	No disclosure on file
Ying Wu	No disclosure on file

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