7.3.5 Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL)

Identification: Gender/Age: Female, 19 years old

Background: University student, no known comorbidities

Family history: Mother with migraine without aura

History of Present Illness (HPI): Clinical presentation:

Three episodes in the last 5 days of:

Severe (9/10) pulsatile headache, unilateral right

Preceded by visual aura (scintillating scotomas) lasting 15-20 minutes

Followed by paresthesias in the left upper limb (30-45 minutes duration)

Associated nausea and photophobia

Important characteristics:

Complete recovery between episodes

No permanent neurological deficits

No fever

Physical/Neurological Examination:
General: Patient conscious, oriented, hemodynamically stable

Neurological:

Normal examination at the time of evaluation

No meningeal signs

Fundoscopy without alterations

Complementary Exams:
Lumbar Puncture:

Opening pressure: 18 cmH2O

56 leukocytes/mm3 (95% lymphocytes)

Protein: 55 mg/dL

Glucose: 60 mg/dL (concomitant blood glucose 98 mg/dL)

Negative cultures

Cranial MRI with MR Angiography: Normal

EEG: Mild diffuse slowing, no epileptiform activity