How to HaNDL This Case?

Filipa Silva, Rita Ferraz, Nelia Neves, Paulo Andrade, Claudia Carvalho, Antonio Sarmento


Headache and neurological deficits with cerebrospinal fluid (CSF) lymphocytosis (HaNDL) is a self-limited, benign neurological entity that may constitute a diagnosis dilemma since it can mimic a variety of conditions including aseptic meningitis, meningoencephalitis, migraine with aura and stroke. We report a case of a 31-year-old Caucasian man admitted at the emergency department for sudden onset of dysarthria and paresthesias in the right upper limb, after 2 weeks of complaints of headache associated with mild nausea. After extensive blood investigation, CSF study, electroencephalogram and neuroimaging, central nervous system infections, autoimmune and vascular diseases were excluded. CSF study revealed lymphocytic pleocytosis, normal glucose and slightly elevated protein concentration. Magnetic resonance imaging (MRI) showed a diffuse leptomeningeal enhancement, a decreased and delayed perfusion to the entire left hemisphere. The patient improved with supportive and symptomatic management. Two days after discharge, he developed a similar clinical picture and recovered completely 30 minutes after admission. His repeated lumbar puncture (LP) showed progressive improvement as expected due to the clinical resolution and MRI did not reveal any of the previous changes. Given the presentation (clinical picture, imaging and CSF studies), the subsequent similar and self-limited episode and having excluded other causes, a final diagnosis of HaNDL was made. HaNDL is one of the most frequent stroke mimics and probably not as rare as commonly thought. It has a good prognosis since this monophasic, self-limiting condition runs its course usually within a few months from onset, without any neurological sequelae.

J Med Cases. 2016;7(3):84-86


HaNDL; Headache; Stroke; Lymphocytic pleocytosis; Cerebrospinal fluid; Cerebral blood flow; MRI

Full Text: HTML PDF

Browse  Journals  


Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics


World Journal of Oncology

Gastroenterology Research

Journal of Hematology


Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity


Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research


Journal of Neurology Research

International Journal of Clinical Pediatrics



Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)

This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website:   editorial contact:
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.

Disclaimer: The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.