Abstract Details

Title HaNDLing the Unknown: A Rare Case of Pediatric Headache

Topic Child Neurology and Developmental Neurology

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 6-018

Objective

We describe a pediatric patient with syndrome of transient headache and neurological deficits with cerebrospinal fluid (CSF) lymphocytosis (HaNDL)

Background HaNDL syndrome, is a rare benign secondary headache disorder described in the International Classification of Headache Disorders 3 (ICHD-3). It requires one or more episodes of migraine-like headache, the presence of transient neurological impairments, and elevated CSF lymphocytes with negative etiological studies. There must be evidence of causation between the headache and the CSF findings. Finally, there must not be a better fitting ICHD-3 diagnosis to explain the clinical picture. HaNDL is self-limited, however, the underlying etiology remains poorly understood. To date, few pediatric cases have been documented.

Design/Methods Medical chart and literature review.

Results An 8-year-old girl with episodic headaches developed recurrent severe headaches multiple times a week described as bifrontal, stabbing, and associated with photophobia, phonophobia, nausea, and vomiting. During this period, she also developed left- sided facial numbness and blurry vision. She was started on Topiramate for prevention of presumed migraine with aura. However, over the course of 3 months, she required multiple hospitalizations due to discrete episodes of headache, with blurry vision, and/or left-sided facial numbness. Several lumbar punctures performed while she was symptomatic showed elevated opening pressure and persistent CSF lymphocytosis. Extensive infectious, rheumatological, and autoimmune work ups were unrevealing. MRI of the brain, orbits, and MRV with and without contrast were normal. Her symptoms resolved each time with supportive care only. Currently, she has returned to her baseline headache frequency.

Conclusions Although likely underdiagnosed and infrequently reported in pediatric populations, HaNDL should be considered a potential diagnosis in healthy children who present with recurrent migraine-like headaches with associated hemiparaesthesia, dysphasia, or hemiparesis. Once confirmed, unnecessary invasive studies can be avoided. Given its favorable prognosis, education and reassurance should be the mainstay of management.

Authors/Disclosures
Maria Gonzalez, MD PRESENTER	Dr. Gonzalez has nothing to disclose.
Manasa Sudheendra, MBBS (Texas Children's Hospital/ Baylor College of Medicine)	Dr. Sudheendra has nothing to disclose.
Peter W. Campbell, MD, PhD (Baylor College of Medicine)	Dr. Campbell has nothing to disclose.
Aishwarya Pareek, MD	No disclosure on file

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