Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic

Akhila Kumar Panda; Muralikrishnan K; Garima Sarraf; Seema Mallik

doi:doi:10.11648/j.ajim.20130101.12

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Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic

Akhila Kumar Panda, Muralikrishnan K, Garima Sarraf, Seema Mallik

Published in American Journal of Internal Medicine (Volume 1, Issue 1)

Received: 13 May 2013 Published: 10 June 2013

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Abstract

Headache with neurological deficits and cerebrospinal fluid (CSF) lymphocytosis (HaNDL), a benign condition, known to have confused physicians and neurologists presenting like transient Ischemic Attacks (TIA), central nervous system infections and encephalitis of various etiology. HaNDL is typically seen in young adults, manifested as a triad of headache, transient focal neurological deficits and CSF lymphocytosis. The authors report the case of a 50 -year- old man with episodic headache associated with neck stiffness, altered sensorium and symptoms of acute psychosis. After extensive evaluation including neuroimaging, CSF study, different blood investigations to exclude possible central nervous system infections, autoimmune encephalitis and CNS vascular disease, a diagnosis of HaNDL was arrived. The patient improved with supportive and symptomatic management. HaNDL can present with symptoms akin to meningitis and psychosis. Due caution should be exercised before arrival at the diagnosis of HaNDL, which is a based on exclusion of other life threatening neurologic illness.

Published in	American Journal of Internal Medicine (Volume 1, Issue 1)
DOI	10.11648/j.ajim.20130101.12
Page(s)	7-9
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2013. Published by Science Publishing Group

Keywords

Pseudo migraine, Meningism, Psychosis, CSF, MRI

References

[1]	Maarten G. Lansberg, Andrew R. Woofenden, Alexander M. Norbash, Don B. Smith and Gregory B. Albers. Headache with neurological deficits and CSF lymphocytosis: A transient ischemic attack mimic. Journal of Stroke and Cerebrovascular Diseases.1999:8: pp 42 – 44.
[2]	Bartleson JD, Swanson JN, Whisnant JP. A migrainous syndrome with cerebrospinal fluid pleocytosis. Neurology 1981;31: 1257 – 1262.
[3]	Berg MJ, Williams LS. The transient syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis. Neurology 1995; 45: 1648 – 1654.
[4]	Gomez – Aranda F, Carradillas F, Marti – Masso JF, et al. Pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis. A report of 50 cases. Brain 1997; 120: 1105 – 1113.
[5]	Bo-Lin Ho, Chiou-: Lian Lai, Chung-Yao Hsu. Acute confusion in headache with neurologic deficits and cerebrospinal fluid lymphocytosis syndrome. Am J Emerg Med. 2012 Nov;30 (9):2078.e7-8.
[6]	Mateo I, Pinedo A, Gomez – Beldarrain M, et al. Acute confusional state secondary to transient headache and neurological deficits with cerebrospinal fluid lymphocytosis. Neurologia 2004; 19: 763 – 765.
[7]	Giorgetti A, Mariani G, Patruno GM, et al. The transient syndrome of headache with neurological deficits, cerebrospinal fluid pleocytosis and acute confusional state: a case report. J Headache Pain 2005; 6: 476.
[8]	Parissis D, Ionnidis P, Balamoutsos G, et al. Confusional state in syndrome of HaNDL. Headache 2011; 51: 1285 – 1288.
[9]	Kremenitzer M, Golden GS. Letter. Hemiplegic migraine: Cerebrospinal fluid abnormalities. J Paediatr 1974; 85: 139.
[10]	Schraeder PL, Burns KA. Hemiplegic migraine associated with an aseptic meningeal reaction. Arch Neurol 1980;37: 377 – 379.

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APA Style

Akhila Kumar Panda, Muralikrishnan K, Garima Sarraf, Seema Mallik. (2013). Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic. American Journal of Internal Medicine, 1(1), 7-9. https://doi.org/10.11648/j.ajim.20130101.12

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ACS Style

Akhila Kumar Panda; Muralikrishnan K; Garima Sarraf; Seema Mallik. Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic. Am. J. Intern. Med. 2013, 1(1), 7-9. doi: 10.11648/j.ajim.20130101.12

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AMA Style

Akhila Kumar Panda, Muralikrishnan K, Garima Sarraf, Seema Mallik. Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic. Am J Intern Med. 2013;1(1):7-9. doi: 10.11648/j.ajim.20130101.12

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@article{10.11648/j.ajim.20130101.12,
  author = {Akhila Kumar Panda and Muralikrishnan K and Garima Sarraf and Seema Mallik},
  title = {Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic},
  journal = {American Journal of Internal Medicine},
  volume = {1},
  number = {1},
  pages = {7-9},
  doi = {10.11648/j.ajim.20130101.12},
  url = {https://doi.org/10.11648/j.ajim.20130101.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20130101.12},
  abstract = {Headache with neurological deficits and cerebrospinal fluid (CSF) lymphocytosis (HaNDL), a benign condition, known to have confused physicians and neurologists presenting like transient Ischemic Attacks (TIA), central nervous system infections and encephalitis of various etiology. HaNDL is typically seen in young adults, manifested as a triad of headache, transient focal neurological deficits and CSF lymphocytosis. The authors report the case of a 50 -year- old man with episodic headache associated with neck stiffness, altered sensorium and symptoms of acute psychosis. After extensive evaluation including neuroimaging, CSF study, different blood investigations to exclude possible central nervous system infections, autoimmune encephalitis and CNS vascular disease, a diagnosis of HaNDL was arrived. The patient improved with supportive and symptomatic management. HaNDL can present with symptoms akin to meningitis and psychosis. Due caution should be exercised before arrival at the diagnosis of HaNDL, which is a based on exclusion of other life threatening neurologic illness.},
 year = {2013}
}

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TY  - JOUR
T1  - Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic
AU  - Akhila Kumar Panda
AU  - Muralikrishnan K
AU  - Garima Sarraf
AU  - Seema Mallik
Y1  - 2013/06/10
PY  - 2013
N1  - https://doi.org/10.11648/j.ajim.20130101.12
DO  - 10.11648/j.ajim.20130101.12
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 7
EP  - 9
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20130101.12
AB  - Headache with neurological deficits and cerebrospinal fluid (CSF) lymphocytosis (HaNDL), a benign condition, known to have confused physicians and neurologists presenting like transient Ischemic Attacks (TIA), central nervous system infections and encephalitis of various etiology. HaNDL is typically seen in young adults, manifested as a triad of headache, transient focal neurological deficits and CSF lymphocytosis. The authors report the case of a 50 -year- old man with episodic headache associated with neck stiffness, altered sensorium and symptoms of acute psychosis. After extensive evaluation including neuroimaging, CSF study, different blood investigations to exclude possible central nervous system infections, autoimmune encephalitis and CNS vascular disease, a diagnosis of HaNDL was arrived. The patient improved with supportive and symptomatic management. HaNDL can present with symptoms akin to meningitis and psychosis. Due caution should be exercised before arrival at the diagnosis of HaNDL, which is a based on exclusion of other life threatening neurologic illness.
VL  - 1
IS  - 1
ER  -

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Author Information

Akhila Kumar Panda

Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
Muralikrishnan K

Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
Garima Sarraf

Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
Seema Mallik

Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India

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Plain Text BibTeX RIS

APA Style

Akhila Kumar Panda, Muralikrishnan K, Garima Sarraf, Seema Mallik. (2013). Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic. American Journal of Internal Medicine, 1(1), 7-9. https://doi.org/10.11648/j.ajim.20130101.12

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ACS Style

Akhila Kumar Panda; Muralikrishnan K; Garima Sarraf; Seema Mallik. Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic. Am. J. Intern. Med. 2013, 1(1), 7-9. doi: 10.11648/j.ajim.20130101.12

Copy | Download

AMA Style

Akhila Kumar Panda, Muralikrishnan K, Garima Sarraf, Seema Mallik. Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic. Am J Intern Med. 2013;1(1):7-9. doi: 10.11648/j.ajim.20130101.12

Copy | Download

@article{10.11648/j.ajim.20130101.12,
  author = {Akhila Kumar Panda and Muralikrishnan K and Garima Sarraf and Seema Mallik},
  title = {Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic},
  journal = {American Journal of Internal Medicine},
  volume = {1},
  number = {1},
  pages = {7-9},
  doi = {10.11648/j.ajim.20130101.12},
  url = {https://doi.org/10.11648/j.ajim.20130101.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20130101.12},
  abstract = {Headache with neurological deficits and cerebrospinal fluid (CSF) lymphocytosis (HaNDL), a benign condition, known to have confused physicians and neurologists presenting like transient Ischemic Attacks (TIA), central nervous system infections and encephalitis of various etiology. HaNDL is typically seen in young adults, manifested as a triad of headache, transient focal neurological deficits and CSF lymphocytosis. The authors report the case of a 50 -year- old man with episodic headache associated with neck stiffness, altered sensorium and symptoms of acute psychosis. After extensive evaluation including neuroimaging, CSF study, different blood investigations to exclude possible central nervous system infections, autoimmune encephalitis and CNS vascular disease, a diagnosis of HaNDL was arrived. The patient improved with supportive and symptomatic management. HaNDL can present with symptoms akin to meningitis and psychosis. Due caution should be exercised before arrival at the diagnosis of HaNDL, which is a based on exclusion of other life threatening neurologic illness.},
 year = {2013}
}

Copy | Download

TY  - JOUR
T1  - Headache with Neurological Deficits and CSF Lymphocytosis: A Meningism and Psychosis Mimic
AU  - Akhila Kumar Panda
AU  - Muralikrishnan K
AU  - Garima Sarraf
AU  - Seema Mallik
Y1  - 2013/06/10
PY  - 2013
N1  - https://doi.org/10.11648/j.ajim.20130101.12
DO  - 10.11648/j.ajim.20130101.12
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 7
EP  - 9
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20130101.12
AB  - Headache with neurological deficits and cerebrospinal fluid (CSF) lymphocytosis (HaNDL), a benign condition, known to have confused physicians and neurologists presenting like transient Ischemic Attacks (TIA), central nervous system infections and encephalitis of various etiology. HaNDL is typically seen in young adults, manifested as a triad of headache, transient focal neurological deficits and CSF lymphocytosis. The authors report the case of a 50 -year- old man with episodic headache associated with neck stiffness, altered sensorium and symptoms of acute psychosis. After extensive evaluation including neuroimaging, CSF study, different blood investigations to exclude possible central nervous system infections, autoimmune encephalitis and CNS vascular disease, a diagnosis of HaNDL was arrived. The patient improved with supportive and symptomatic management. HaNDL can present with symptoms akin to meningitis and psychosis. Due caution should be exercised before arrival at the diagnosis of HaNDL, which is a based on exclusion of other life threatening neurologic illness.
VL  - 1
IS  - 1
ER  -

Copy | Download