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2.1
HaNDL Syndrome

Presentation

Conclusions Here we presented a typical case of HaNDL presenting with transient episodes of agraphia, a transient focal neurological deficit non previously reported. [cureus.com]

He had not presented fever or any other systemic symptoms in the previous days, but in the previous month he had presented a mild upper respiratory tract infection, with odynophagia and mild fever, and a PCR test had yielded positive results for SARS-CoV [elsevier.es]

Our patient was a young female presenting with severe headache and convulsions, a rare presentation for HaNDL syndrome. [biomedgrid.com]

Implications for Nursing Increased recognition of this syndrome may help prevent unnecessary tests and treatments when patients present with recurrent episodes. [connect.springerpub.com]

Prodromal symptoms, including fever, may also be present. [journal.nzma.org.nz]

Gastrointestinal

  • Odynophagia

    He had not presented fever or any other systemic symptoms in the previous days, but in the previous month he had presented a mild upper respiratory tract infection, with odynophagia and mild fever, and a PCR test had yielded positive results for SARS-CoV [elsevier.es]

Eyes

  • Blurred Vision

    She had several short-lived episodes of migratory neurology; suffering patches of bilateral asymmetrical numbness, slurred speech, blurred vision and confusion, which lasted from minutes to hours. There was no viral prodrome. [journal.nzma.org.nz]

Neurologic

  • Dysarthria

    We report a case of a 24-year-old female who developed dysarthria for several hours and decreased use of the right arm with right-sided facial weakness. [ejnpn.springeropen.com]

Workup

An extensive infectious workup was negative. [biomedgrid.com]

In a single-center study of 433 patients who presented to the hospital with acute headache complaints (including thunderclap headache), only 1 patient was diagnosed with HaNDL after workup [12]. [hindawi.com]

Infectious workup, including HSV PCR was negative. Continuous video EEG monitoring did not reveal any epileptiform abnormalities. Patient was discharged and a repeat MRI brain was planned 1 month after and is pending. [n.neurology.org]

Third, in the CSF analysis, lymphocytic pleocytosis was discovered, and an extensive aetiological workup revealed no infectious or inflammatory source, including viral, bacterial, fungal, treponemal, and NMDA-receptor antibodies. [cureus.com]

The WBC normalized and septic workup was negative. Bases on the history, physical exam and LP findings the diagnosis of HaNDL syndrome was made. [atm.amegroups.com]

Microbiology

  • Toxoplasma Gondii

    Serology tests for HCV, EBV, CMV, HSV, VZV, HHV-6, HHV-7, HHV-8, syphilis, Rickettsia, Toxoplasma gondii, Borrelia, and Brucella yielded negative results, as did CSF PCR assays for viral infection. [elsevier.es]

Treatment

We evaluated the severity of headache before and after daily treatment of two groups for one week. [elitmed.hu]

We started empirical treatment with intravenous aciclovir and lacosamide, and the patient was admitted to the neurology ward. [elsevier.es]

Treatment and prognosis Treatment is symptomatic and the prognosis is considered excellent. Clinically can mimic various serious, including life-threatening, diseases, such as stroke and meningoencephalitis. References Promoted articles (advertising) [radiopaedia.org]

The prognosis of this illness is benign and the treatment is symptomatic. However, symptoms including elevated IPC, papilledema and brain herniation may be observed, recquering urgent treatment. [oatext.com]

Implications for Nursing Increased recognition of this syndrome may help prevent unnecessary tests and treatments when patients present with recurrent episodes. [connect.springerpub.com]

Prognosis

Treatment and prognosis Treatment is symptomatic and the prognosis is considered excellent. Clinically can mimic various serious, including life-threatening, diseases, such as stroke and meningoencephalitis. References Promoted articles (advertising) [radiopaedia.org]

However, HaNDL may be accompanied by elevated intracranial pressure (ICP) and papilledema [1], and cerebral herniation [8], which worsen de prognosis. [oatext.com]

Treatment is symptomatic and the prognosis is excellent. A literature review of the topic is discussed. [casereports.bmj.com]

Prognosis is usually good. References 1. Cifelli, A; Vaithianathar, L. (2011). Syndrome of transient Headache and Neurological Deficits with cerebrospinal fluid Lymphocytosis (HaNDL). [n.neurology.org]

The prognosis was good, and the symptoms resolved. Repeated physical examination after 48 h was unremarkable. [ejnpn.springeropen.com]

Etiology

This suggests a possible role of a viral infection in the etiology of HaNDL which is mostly immune related. [ejnpn.springeropen.com]

Background: HaNDL is an uncommon but self limiting benign headache disorder of an unknown etiology. Diagnosis is essentially based on the clinical and CSF findings with a relatively normal brain MRI. [n.neurology.org]

In conclusion, the exact etiology behind HaNDL syndrome remains poorly understood. [atm.amegroups.com]

Cortical irritation from an aseptic meningitis that triggers a migraine-like cortical spreading depression appears to be the most plausible etiology that explains the presentation of HaNDL syndrome [5,16]. [biomedgrid.com]

We additionally review the 30 previously reported pediatric cases of HaNDL syndrome, with a focus on possible etiologic and pathophysiologic mechanisms of disease. [pubmed.ncbi.nlm.nih.gov]

Pathophysiology

The pathophysiology remains unclear although changes in the neurovascular resemble those found in migraine, which are thought to be triggered by an infectious process. MRI MRI of the brain is usually normal. [radiopaedia.org]

We additionally review the 30 previously reported pediatric cases of HaNDL syndrome, with a focus on possible etiologic and pathophysiologic mechanisms of disease. [pubmed.ncbi.nlm.nih.gov]

The pathophysiology remains unclear although changes in the neurovascular resemble those found in migraine, which are thought to be triggered by an infectious process. [casereports.bmj.com]

The syndrome of transient headache with neurological deficits and CSF lymphocytosis (HaNDL): electrophysiological findings suggesting a migrainous pathophysiology. Cephalalgia 2005;25:754-8. Kappler J, Mohr S, Steinmetz H. [atm.amegroups.com]

It may be explained on the basis of migrainous or post-viral/inflammatory pathophysiology. The prognosis of this illness is benign and the treatment is symptomatic. [oatext.com]

Prevention

Implications for Nursing Increased recognition of this syndrome may help prevent unnecessary tests and treatments when patients present with recurrent episodes. [connect.springerpub.com]

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