Unusual Presentation Of HaNDL Syndrome (P3.116)

Objective: NA Background: Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) consists of recurrent headaches associated with focal neurological signs such as motor, sensory or aphasic symptoms. HaNDL can mimic various serious diseases, such as stroke, meningoencephalitis. Comprehensive evaluation and complete work up should be sought before this diagnosis is made. Treatment is symptomatic and the prognosis is excellent. We report a unique case of HaNDL syndrome associated with global aphasia and transient global amnesia. Design/Methods: Case Presentation: 18-year-old patient presented with two weeks history of recurrent attacks of throbbing headache lasting for few hours, associated with nausea, vomiting, photophobia and phonophobia. Patient was asymptomatic between the attacks. During the last visit to the emergency department, he was suffering from severe throbbing headache; he was alert, agitated, mute and not responding to verbal commands; he recovered completely after 3 hours; when asked later on, he vaguely recalled the headache but was not able to make any new memories following that event. Work up including MRI/MRA/MRV (normal). Electroencephalogram showed slowing in the left hemisphere; Lumbar puncture a high opening pressure of 47 cm; white blood cells: 167, 91% lymphocytes, protein:0.47 g/l, glucose:3.2 g/l; the work up confirmed the diagnosis of HaNDL syndrome. During the following 2 months, patient had four more attacks of headache, less severe and not associated with any neurological deficit. Results: NA Conclusions: This patient came to the emergency with the clinical picture of global aphasia (muteness and unresponsiveness to commands) and transient global amnesia (anterograde more than retrograde amnesia); this is a very unusual presentation of HaNDL syndrome; this combination was not reported previously in the literature. Despite being a rare condition, HaNDL syndrome should be considered in the differential diagnoses of patients presenting with headache and transient neurological deficit; transient global amnesia could be an associated finding. Study Supported by: NA Disclosure: Dr. Ali has nothing to disclose. Dr. Mesraoua has nothing to disclose. Dr. Dsouza has nothing to disclose. Dr. Alhussein has nothing to disclose. Dr. El Sheikh has nothing to disclose. Dr. Mhjob has nothing to disclose. Dr. Melikyan has nothing to disclose. Dr. Al Hail has nothing to disclose. Dr. Deleu has nothing to disclose.