Syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis masquerading as meningitis in HIV patient
Syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) is described as “headache attributed to noninfectious inflammatory disease” featuring, as its name suggests, headache that mimics migraine in addition to neurologic symptoms such as hemiparesis, hemiparesthesia and dysphagia. We report a case of a 50-year-old African-American female who presented with headache, malaise and subsequent hemiparesis. Despite bearing a close resemblance to an acute episode of meningitis clinically, cerebrospinal fluid (CSF) analysis of the patient was only positive for isolated elevation in white cell count. The patient was diagnosed with HaNDL syndrome which is characterized by transient headache and neurologic deficits with CSF lymphocytosis. While the overall condition often appears substantial, the disease is self-limiting and patients usually recover spontaneously.