Headache with temporary neurological symptoms and lymphocytic pleocytosis: a case report and etiologic hypothesis

A 30-year-old man without previous attacks of migraine, despite a family history of migraine, presented with moderate headache and temporary focal neurological signs and symptoms. The patient had had, two weeks previously, a prodromic flu-like illness. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis and increased total protein. Extensive microbiological determinations were negative. Routine hematological, immunological, blood and urine tests were normal. Electroencephalography showed a focal slowing in the right temporal area. Brain SPECT, performed during a symptom-free period, revealed decreased tracer uptake in the left temporal and insula cortices,topographicallyconsistent with abnormalities on brainstem auditory evoked potentials. Computed tomography and magnetic resonance imaging of the brain were normal. A cardiovascular examination provided normal results. The patient completely recovered within 2 days. This condition is suggestive of “headache with neurologic deficits and CSF lymphocytosis” (HaNDL syndrome). I hypothesize that this syndrome could be produced by the direct action of a virus.