Abstract
The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) is a self-limited condition. Confusional states are uncommonly reported as a clinical manifestation of this syndrome. Here, I report a 76-year-old female who presented with headache, confusion, and agitation with a mild CSF lymphocytosis. Other workup to determine the cause of her altered mental status was otherwise negative. The literature available in the English language on HaNDL syndrome is reviewed, including its history, pathophysiology, possible associations with migraine and stroke, and previously reported cases of confusional states in this syndrome. While HaNDL syndrome has been a described entity since the 1980s, its pathophysiology has yet to be clearly defined.
Highlights
The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) is a self-limited condition characterized by the findings described in its name
This condition was first described in the early 1980s and has been called pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis (PMP)
As an example of an uncommon clinical manifestation of this syndrome, I report a 76-year-old female who presented with altered mental status with workup consistent with HaNDL syndrome; her symptoms eventually resolved without treatment
Summary
The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) is a self-limited condition characterized by the findings described in its name. This condition was first described in the early 1980s and has been called pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis (PMP). Clinical manifestations appear to be diverse, and its etiology is not fully delineated though correlations have been made with both migraine and stroke. As an example of an uncommon clinical manifestation of this syndrome, I report a 76-year-old female who presented with altered mental status with workup consistent with HaNDL syndrome; her symptoms eventually resolved without treatment
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