scholarly journals Rare mimicker of transient ischaemic attacks: the syndrome of transient headache and neurological deficits with cerebrospinal luid lymphocytosis

2019 ◽  
Vol 7 (6) ◽  
pp. 2442
Author(s):  
Philo Hazeena ◽  
Naga Karthik Vanukuri ◽  
Shankar V.
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical History ◽  
Severe Headache ◽  
Neurological Deficits ◽  
Serial Imaging ◽  
Transient Ischaemic Attacks ◽  
Neurologic Deficits ◽  
High Degree ◽  
The Brain

The syndrome of transient headache and neurologic deficits associated with cerebrospinal fluid lymphocytosis (HaNDL) is a benign and self limiting disorder characterized by 1 or more episodes of severe headache and transient neurologic deficits with lymphocytic pleocytosis in the cerebrospinal fluid. We report a case of a 30-year-old male who presented with four episodes of headache followed by hemi paresis and hemisensory loss in a week the patient was completely asymptomatic in between each episode of headache with neurological deficits. Persistent serial imaging to visualize the brain were normal with evidence of cerebrospinal fluid lymphocytosis, which lead to the diagnosis of HaNDL. We need to advocate a high degree of suspicion for HaNDL in the background of strong clinical history and findings, when imaging is normal.

HaNDL Syndrome: Case Report and Literature Review

2018 ◽  
Vol 34 (3) ◽  
pp. 161-167 ◽  
Author(s):  
Amy Armstrong-Javors ◽  
Kalpathy Krishnamoorthy
Keyword(s):  
Cerebrospinal Fluid ◽  
Literature Review ◽  
Severe Headache ◽  
Resonance Imaging ◽  
Neurologic Deficits ◽  
Elevated Protein ◽  
Episodic Nature ◽  
Magnetic Resonance Imaging Mri ◽  
Fundoscopic Examination ◽  
Pathophysiologic Mechanisms

Headache and Neurologic Deficits with cerebrospinal fluid Lymphocytosis (HaNDL) syndrome is a rare stroke mimicker characterized by moderate to severe headache temporally associated with transient neurologic deficits, typically hemiparesis, hemisensory disturbance, and/or aphasia. Cerebrospinal fluid studies reveal a lymphocytosis and elevated protein. Episodes recur over a period no longer than 3 months. Here we describe the case of a 16-year-old boy who presented with 3 episodes of self-resolving neurologic deficits, papilledema on fundoscopic examination, and leptomeningeal enhancement on magnetic resonance imaging (MRI). We additionally review the 30 previously reported pediatric cases of HaNDL syndrome, with a focus on possible etiologic and pathophysiologic mechanisms of disease. The reported case and literature review highlight the benign episodic nature of this likely underrecognized syndrome as well as the higher than expected frequency of abnormal neuroimaging findings.

Naegleria fowleri Hemorrhagic Meningoencephalitis: Report of Two Fatalities in Children

2004 ◽  
Vol 19 (3) ◽  
pp. 231-233 ◽  
Author(s):  
Darin T. Okuda ◽  
Hank J. Hanna ◽  
Stephen W. Coons ◽  
John B. Bodenstelner
Keyword(s):  
Cerebrospinal Fluid ◽  
Brain Stem ◽  
Mass Effect ◽  
Severe Headache ◽  
Neurologic Examination ◽  
Naegleria Fowleri ◽  
Neck Stiffness ◽  
Nuchal Rigidity ◽  
Nægleria Fowleri ◽  
The Brain

Two cases of hemorrhagic meningoencephalitis secondary to Naegleria fowleri infection confirmed by postmortem analysis are described. The first patient is a 5-year-old boy who presented with a severe headache, neck stiffness, and lethargy. His neurologic examination was significant for somnolence and nuchal rigidity. Cerebrospinal fluid studies and structural neuroimaging were consistent with hemorrhagic meningoencephalitis. Another 5-year-old boy presented to a different institution 2 miles away in the same week with similar complaints. Both patients declined rapidly and expired within 48 hours of admission secondary to transtentorial herniation caused by the mass effect of inflammation, edema, and hemorrhage with displacement of the brain stem. Histopathologic and immunochemistry analysis of brain tissue revealed the presence of Naegleria trophozoites in both cases.

scholarly journals Human CNS barrier-forming organoids with cerebrospinal fluid production

Science ◽  
2020 ◽  
Vol 369 (6500) ◽  
pp. eaaz5626 ◽  
Author(s):  
Laura Pellegrini ◽  
Claudia Bonfio ◽  
Jessica Chadwick ◽  
Farida Begum ◽  
Mark Skehel ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Secretion ◽  
Fluid Production ◽  
New Compounds ◽  
High Degree ◽  
The Brain ◽  
Degree Of Similarity ◽  
By Products

Cerebrospinal fluid (CSF) is a vital liquid, providing nutrients and signaling molecules and clearing out toxic by-products from the brain. The CSF is produced by the choroid plexus (ChP), a protective epithelial barrier that also prevents free entry of toxic molecules or drugs from the blood. Here, we establish human ChP organoids with a selective barrier and CSF-like fluid secretion in self-contained compartments. We show that this in vitro barrier exhibits the same selectivity to small molecules as the ChP in vivo and that ChP-CSF organoids can predict central nervous system (CNS) permeability of new compounds. The transcriptomic and proteomic signatures of ChP-CSF organoids reveal a high degree of similarity to the ChP in vivo. Finally, the intersection of single-cell transcriptomics and proteomic analysis uncovers key human CSF components produced by previously unidentified specialized epithelial subtypes.

A Man With Recurrent Headache and Focal Neurologic Deficits

2021 ◽  
pp. 222-224
Author(s):  
Jaclyn R. Duvall ◽  
Jerry W. Swanson
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebral Angiography ◽  
Blood Cells ◽  
White Blood Cells ◽  
Severe Headache ◽  
First Episode ◽  
Benign Condition ◽  
Left Hand ◽  
Neurologic Deficits ◽  
Symptomatic Management

A 42-year-old healthy man sought care for transient episodes of neurologic deficits followed by severe headache. The first episode began with left hand weakness, numbness, and dysarthria, followed approximately 1 hour later by a right temporal headache. His symptoms spontaneously resolved after 8 hours. He had a second episode 2 days later manifested by confusion and bilateral lower extremity numbness, again followed by severe headache with symptoms resolving within 12 hours. A total of 8 episodes occurred over 3 weeks, each lasting 8 to 24 hours, with spontaneous resolution each time. His most recent episode occurred during cerebral angiography. Cerebrospinal fluid evaluation showed opening pressure, 190 mm H2O; white blood cells, 205/μ‎L, 97% lymphocytes; protein, 95 mg/dL; and glucose, 40 mg/dL. Electroencephalography demonstrated right greater than left generalized slowing, with increased-voltage rhythmic delta wave activity, in the frontal regions predominantly. Conventional cerebral angiography findings were normal, but the test appeared to provoke the patient’s previous episode. Neurologic examination was normal after his most recent episode resolved, and no further episodes were reported. This case highlights a typical presentation of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis. Because the disorder was self-limited, treatment was aimed at symptomatic management of headache. In this case patient with a secure diagnosis of headache and neurologic deficits with cerebrospinal fluid lymphocytosis and stereotypical episodes limited to 3 months after the initial presentation, additional testing was not indicated. Headache and neurologic deficits with cerebrospinal fluid lymphocytosis is a rare, self-limited, benign condition with migrainelike headache episodes accompanied by transient neurologic deficits usually lasting more than 4 hours, with some deficits lasting more than 24 hours.

scholarly journals Acute disseminated encephalomyelitis (ADEM) associated with COVID-19

2020 ◽  
Vol 13 (12) ◽  
pp. e239597
Author(s):  
Lawrence Langley ◽  
Claudia Zeicu ◽  
Louise Whitton ◽  
Mathilde Pauls
Keyword(s):  
Cerebrospinal Fluid ◽  
Critical Care ◽  
Respiratory Failure ◽  
Brain Mri ◽  
Acute Disseminated Encephalomyelitis ◽  
Neurological Deficits ◽  
Oligoclonal Bands ◽  
High Dose ◽  
The Brain

A 53-year-old man admitted to the critical care secondary to respiratory failure due to COVID-19 developed agitation and global hypotonia. Brain MRI revealed bilateral hyperintense lesions throughout the brain and cerebrospinal fluid identified oligoclonal bands. Intravenous high-dose glucocorticoids were administered followed by an oral tapering dose and the patient clinically improved. Acute disseminated encephalomyelitis should be considered in patients with COVID-19 who present with altered mentation and polyfocal neurological deficits.

scholarly journals Syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL)

2018 ◽  
pp. 68-71
Author(s):  
Laryssa Crystinne Azevedo Almeida ◽  
Marcelo Moraes Valença
Keyword(s):  
Cerebrospinal Fluid ◽  
Emergency Room ◽  
Clinical Picture ◽  
Narrative Review ◽  
Neurological Deficits ◽  
Headache Syndrome ◽  
Neurologic Deficits

The authors make a narrative review on "headache syndrome and transient neurological deficits with cerebrospinal fluid lymphocytosis (CRL)," a rare, underdiagnosed disorder of little knowledge by physicians specializing in care in the emergency room. Aspects of the clinical picture, diagnosis, prognosis, and treatment are discussed  

La sindrome “Cefalea e deficit neurologici transitori con linfocitosi liquorale”: un’altra encefalopatia autoimmune?

2021 ◽  
Vol 24 (8) ◽  
pp. 241
Author(s):  
Maria Elisa Morelli ◽  
Marco Carrozzi
Keyword(s):  
Cerebrospinal Fluid ◽  
Migraine Headache ◽  
Neurological Deficits ◽  
Age Group ◽  
Impaired Consciousness ◽  
Neurologic Deficits ◽  
Paediatric Age ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Autoimmune Pathogenesis

Headache and neurologic deficits with cerebrospinal fluid lymphocytosis syndrome (HaNDL) is a rare nosographic entity, which mainly affects adults but can also occur in the paediatric age. In the literature, 31 cases in this age group are described. Symptomatology typically lasts about three months with episodes that tend to relapse. An autoimmune pathogenesis has been hypothesized. The paper describes the case of an adolescent who presented with three acute and transient episodes of migraine headache in three days associated with impaired consciousness, focal neurological deficits and CSF lymphocytosis. After treatment with steroidal and non-steroidal anti-inflammatory drugs, the patient did not relapse in the following four months. The treatment indicated in the literature is only supportive (analgesics, antiemetics), however in this case the anti-inflammatory therapy reduced the duration of the episode and the recurrence of further episodes.

scholarly journals Algal Meningoencephalitis due toProtothecaspp. in a Dog

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Alexandre Le Roux ◽  
Sanjeev Gumber ◽  
Rudy W. Bauer ◽  
Nathalie Rademacher ◽  
Lorrie Gaschen
Keyword(s):  
Gastrointestinal Tract ◽  
Head Tilt ◽  
Mass Effect ◽  
Neurological Deficits ◽  
Histological Changes ◽  
Neurologic Deficits ◽  
History Of ◽  
The Brain ◽  
Associated Mass

A 6-year-old Boxer was examined because of progressive neurologic signs, with severe hindlimb ataxia and head tilt on presentation. There was no history of diarrhea or vomiting. MRI of the brain revealed multifocal ill-defined T1-enhancing lesions affecting the cerebrum, brainstem, and cervical meninges, without associated mass effect. Meningoencephalitis was considered the most likely diagnosis. Multiple algae were observed on the cytology of the CSF and were most consistent withProtothecaspp. Antiprotozoal treatment was denied by the owners, and 5 weeks after diagnosis, the dog was euthanized due to progression of the neurologic deficits, and a necropsy was performed. Histological changes in the brain were compatible with severe multifocal protothecal meningoencephalitis. The specificProtothecaspecies was not identified. The gastrointestinal tract was unremarkable on histology. According to this report,Protothecaspp. should be included in the differentials for neurological deficits even in the absence of gastrointestinal signs.

Spontaneous Arterial Subdural Hematoma

Neurosurgery ◽  
1984 ◽  
Vol 14 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Michael McDermott ◽  
Ross J. F. Fleming ◽  
Graham R. Vanderlinden ◽  
William S. Tucker
Keyword(s):  
Dura Mater ◽  
Spontaneous Rupture ◽  
English Literature ◽  
Severe Headache ◽  
Neurological Deficits ◽  
Subdural Space ◽  
Small Artery ◽  
Subdural Hematomas ◽  
History Of ◽  
The Brain

Abstract The occurrence of spontaneous arterial subdural hematomas is very rare. We report five patients who presented with sudden severe headache and who developed progressive neurological deficits, two becoming comatose. None had a history of trauma. A diagnosis of subarachnoid hemorrhage was suspected in all patients, but all proved to have subdural hematomas caused by “spontaneous” rupture of a cortical artery. Nineteen similar cases have been reported in the English literature. The source of bleeding was identified as a cortical artery located near the sylvian region in four of our five patients and in most of the reported cases. There are several possible anatomical situations that may predispose a cortical artery to “spontaneous” rupture: (a) spontaneous rupture of a cortical artery at the point of origin of a fragile arterial twig, especially a right-angled branch, a point of potential weakness; (b) rupture of a small artery traversing the subdural space and connecting a cortical artery to the dura mater (a “bridging” artery); (c) adhesions between a cortical artery and arachnoid or dura mater; (d) a knuckle of cortical artery protruding through the arachnoid and adherent to the dura mater. In each situation, the artery is probably torn by a sudden movement of the brain during a vigorous head movement, not severe enough to be considered trauma.

scholarly journals Borrelia lusitaniae Infection Mimicking Headache, Neurologic Deficits, and Cerebrospinal Fluid Lymphocytosis

2019 ◽  
Vol 34 (12) ◽  
pp. 748-750
Author(s):  
José Pedro Vieira ◽  
Maria João Brito ◽  
Isabel Lopes de Carvalho
Keyword(s):  
Polymerase Chain Reaction ◽  
Cerebrospinal Fluid ◽  
International Headache Society ◽  
Clinical History ◽  
Chain Reaction ◽  
Headache Syndrome ◽  
Neurologic Deficits ◽  
Borrelia Lusitaniae ◽  
Polymerase Chain

Headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL) is a rare headache syndrome included in the Classification of Headache of the International Headache Society as a “headache attributed to non-infectious inflammatory intracranial disease.” We report one 15-year-old patient with clinical history and cerebrospinal fluid findings compatible with the diagnosis of HaNDL in whom Borrelia lusitaniae was identified in cerebrospinal fluid by polymerase chain reaction.

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