HaNDL Syndrome and Seizures: An Unusual Presentation

The Headache and Neurologic Deficits with cerebrospinal fluid Lymphocytosis syndrome (HaNDL) is a rare, benign and self-limited entity of unknown cause, diagnosed by exclusion, characterized by one or more episodes of severe headache, transient neurologic deficits, and cerebrospinal fluid (CSF) lymphocytic pleocytosis. [1], [2], [3]

The most common neurological deficits preceding the headaches are hemiparesis, hemiparesthesia, and aphasia (left hemisphere predominance), while visual symptoms are less common. Although the deficit is usually focal, diffuse manifestations have been reported as an acute confusional state [1], [2], [4], [5], [6], [7] and even though HaNDL has a monophasic course, 75% of patients can suffer from repeated episodes for weeks or months. Noteworthily, signs and symptoms improve as pleocytosis decreases in the CSF. [1], [4], [8]

We report a 35-year-old male diagnosed with HaNDL, with a unique combination of neurologic symptoms including a bilateral tonic-clonic seizure. Written informed consent for this study was obtained, and approval was issued by the Cayetano Heredia Hospital Ethics Committee (ID 206479).

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