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  • Headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome with reversible cytotoxic lesion of the corpus callosum (CLOCC) on MRI of the brain

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Radiology
Headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome with reversible cytotoxic lesion of the corpus callosum (CLOCC) on MRI of the brain
  1. Phuong Hien Duc Nguyen1,
  2. Gi Tae Kwon2 and
  3. Mohammad Ruhul Amin2
  1. 1Nuclear Medicine and PET, Nepean Hospital, Kingswood, New South Wales, Australia
  2. 2Neurology, Nepean Hospital, Kingswood, New South Wales, Australia
  1. Correspondence to Dr Mohammad Ruhul Amin; nepeanneurology{at}gmail.com

Abstract

Headache and neurological deficits with cerebrospinal fluid (CSF) lymphocytosis (HaNDL) is a rare condition characterised by recurrent episodes of headache and transient neurological deficits. This case report presents a young patient initially diagnosed with hemiplegic migraine, having a normal brain CT, with focal cerebral perfusion mismatch not restricted to a single vascular territory on CT angiography. Brain MRI revealed a cytotoxic lesion of the splenium in the corpus callosum (CLOCC), a feature also reported in migraine. However, recurrent headaches with neurological deficits prompted further investigations with CSF analysis and brain MRI, confirming HaNDL and demonstrating reversibility of CLOCC. Recognising HaNDL as a differential diagnosis is essential in patients with recurrent headaches with focal neurological deficits, given the differences in therapeutic approach. The relationship between migraine and HaNDL is not fully understood, but they may share a pathophysiological link. Awareness of this is crucial for accurate diagnosis.

  • Radiology
  • Neuroimaging
  • Headache (including migraines)
  • Neurological injury

https://doi.org/10.1136/bcr-2023-259463

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: PHDN, GTK and MRA. The following authors gave final approval of the manuscript: MRA.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.