Headache with neurological deficits and CSF lymphocytosis: a meningism and psychosis mimic

Headache with neurological deficits and cerebrospinal fluid (CSF) lymphocytosis (HaNDL), a benign condition, known to have confused physicians and neurologists presenting like transient Ischemic Attacks (TIA), central nervous system infections and encephalitis of various etiology. HaNDL is typically seen in young adults, manifested as a triad of headache, transient focal neurological deficits and CSF lymphocytosis. The authors report the case of a 50 -year- old man with episodic headache associated with neck stiffness, altered sensorium and symptoms of acute psychosis. After extensive evaluation including neuroimaging, CSF study, different blood investigations to exclude possible central nervous system infections, autoimmune encephalitis and CNS vascular disease, a diagnosis of HaNDL was arrived. The patient improved with supportive and symptomatic management. HaNDL can present with symptoms akin to meningitis and psychosis. Due caution should be exercised before arrival at the diagnosis of HaNDL, which is a based on exclusion of other life threatening neurologic illness.