Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigaciœn Sanitaria La Princesa, Madrid, Spain.
Cephalalgia. 2018 Jun;38(7):1402-1406. doi: 10.1177/0333102417735846. Epub 2017 Oct 3.
Introduction The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) may mimic stroke when patients present with acute/subacute focal neurological deficits. It would be helpful to identify investigations that assist the neurologist in differentiating between HaNDL and stroke. Case reports We describe three cases that proved to be HaNDL, but were initially considered to be strokes. Hypoperfusion was noted in the CT perfusion (CTP) studies in all three cases, which extended beyond any single cerebral arterial supply. The CTP findings suggested a stroke mimic, and there was no improvement on thrombolysis. MRI failed to show any abnormalities in diffusion and EEGs showed non-epileptiform changes. Lumbar punctures demonstrated a lymphocytic pleocytosis. Conclusion The diagnosis of HaNDL is based on clinical and CSF criteria, but neuroimaging, including CT perfusion, can be helpful in differentiating the clinical syndrome from stroke.
介绍 当患者出现急性/亚急性局灶性神经功能缺损时，伴有脑脊液淋巴细胞增多的短暂性头痛和神经功能缺损综合征（HaNDL）可能类似于中风。如果能确定一些检查方法，将有助于神经科医生区分 HaNDL 和中风，那就太好了。
病例报告 我们描述了三个最初被认为是中风，但后来被证实为 HaNDL 的病例。在所有三个病例的 CT 灌注（CTP）研究中都观察到灌注不足，而且超过了任何单一的脑动脉供应范围。CTP 检查结果提示为中风样发作，溶栓治疗没有改善。MRI 没有显示弥散异常，脑电图显示非癫痫样改变。腰椎穿刺显示淋巴细胞增多。
结论 HaNDL 的诊断基于临床和 CSF 标准，但神经影像学，包括 CT 灌注，有助于将临床综合征与中风区分开来。
