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Transient Headache and Neurologic Deficits With Cerebrospinal Fluid Lymphocytosis (HaNDL syndrome) is a headache disorder in which individuals experience severe to moderate headache attacks, neurological symptoms, and an increase in the amount of a type of white blood cell in the cerebrospinal fluid (lymphocytic pleocytosis). HaNDL syndrome is most often diagnosed in adulthood, although individuals with ages ranging from 7 to 52 have been reported with this condition. The most common neurological symptoms associated with HanDL syndrome include: weakness on one side of the body (hemiparesis), a feeling of altered sensation down one side of the body (hemisensory disturbances), and a loss of the ability to understand or express speech (aphasia). These symptoms usually last between 15 minutes and 2 hours. The cause of HaNDL syndrome is not well understood; however, researchers have suggested a few potential causes, including migraines, inflammation of the tissue that lines the brain and spinal cord, and viral infections. For some individuals, HaNDL syndrome may resolve without treatment, while for others, management of headache and neurological symptoms may be needed.
Source: GARD Last updated on 05-01-20
The signs and symptoms of HaNDL syndrome include severe to moderate headache attacks, neurological symptoms, and an increase in the amount of a type of white blood cell in the cerebrospinal fluid (lymphocytic pleocytosis).
Headaches associated with HaNDL syndrome may be limited to one side of the head or may involve both sides. They can last from one hour to a week and are often associated with nausea, vomiting, and sensitivity to light. Some individuals may also have a fever. Often, the headache occurs after neurological symptoms begin.
Neurological symptoms usually last between 15 minutes and 2 hours, although this may range from 5 minutes to 3 days. Most people additionally experience repeated headaches and symptoms for weeks to months after the initial attack. Neurological symptoms usually differ from one episode to the next.
The most common neurological symptoms are:
Visual signs and symptoms occur less commonly and may include:
People with this condition may also experience swelling of the nerve that runs from the retina in the eye to the brain (papilledema) and dysfunction of the cranial nerve in the brain (sixth nerve palsy). Occasionally, individuals may have episodes of confusion.
Last updated on 05-01-20
HaNDL syndrome is considered a diagnosis of exclusion, meaning it is important to rule out other conditions that may cause similar symptoms in the diagnostic process. Tests that may be used to diagnose this condition include but are not limited to:
Diagnostic guidelines were published in the International Classification of Headache Disorders, 3rd edition, which state that HaNDL syndrome is classified as a headache associated with a noninfectious inflammatory disease. The diagnostic criteria includes:
The diagnostic guidelines are freely available to the general public and can be viewed on the International Classification of Headache Disorders website.
Last updated on 05-01-20
Valença MM, de Oliveira DA, de L. Alice in Wonderland Syndrome, Burning Mouth Syndrome, Cold Stimulus Headache, and HaNDL: Narrative Review Headache. October 2015; 55(9):1233-1248.
Last updated on 04-27-20
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