Syndrome of transient headache and neurological defi cits with cerebrospinal fluid lymphocytosis (HaNDL)

Abstract

This 33-year-old teacher came to our emergency ward due to headache and speech difficulties. One hour earlier he had told his wife that he noticed headache, I feel all my head pulsating darling”. He took a paracetamol pill and went to bed. Twenty minutes later her wife found him agitated and with an incoherent and unintelligible speech. His wife called the emergency services and stroke code was activated. When he arrived he was conscious but tended to remain with his eyes closed and with his hands on his head. Global aphasia was evident and there seemed to be a slight motor weakness of his right extremities, where an indifferent plantar response was obtained. There were no apparent hemianopsia, meningeal signs, and abnormalities in the cranial nerves, including optic fundi, or in the neurovascular examination. Systemic examination was unremarkable, except for a slight axillary temperature elevation (37.6 °C). His blood pressure was 115/067 mmHg. Her wife explained us that 2 days earlier he had visited his GP due to an episode of pulsating headache, which lasted about 5 h and was accompanied by some feeling of numbness in his right hemibody. He was already asymptomatic and his physical exam was normal. His GP thought he had experienced a migraine attack with aura and gave an appointment for his neurologist specialist in 3 weeks.