Romina Moavero1,2, Laura Papetti1, Samuela Tarantino1, Barbara Battan1, Irene Salfa3, Annalisa Deodati4, Riccardo Schiaffini5, Federico Vigevano1, Massimiliano Valeriani1,5,6. 1. Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Bambino Gesù Children's Hospital, Headache Center, IRCCS, Rome, Italy. 2. Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Rome, Italy. 3. DPUO, Tor Vergata University of Rome - Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 4. Diabetology Center, DPUO, Tor Vergata University of Rome - Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 5. Diabetology Center, DPUO, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 6. Center for Sensory Motor Interaction Aalborg University, Aalborg, Denmark.
Abstract
BACKGROUND: Transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) is benign and self-limited, with neurologic deficits including sensory disturbance of one body side, aphasia, nausea/vomiting, weakness, decreased vision, homonymous hemianopsia, photophobia. Acute confusional state can rarely occur. Papilledema and intracranial hypertension have also been described. It is a rare entity mainly affecting adults; however, it has been sporadically described in children and adolescents. MAIN FINDINGS: In this clinical observational study, we describe a clinical series of three consecutive pediatric patients being diagnosed with HaNDL after presenting with altered consciousness, papilledema, and increased intracranial pressure. They all recovered without relapses. CONCLUSION: Presentation during childhood and adolescence is rare; the majority of pediatric cases presented with altered consciousness, which is infrequent in HaNDL. This may suggest that in childhood this symptom might be more common than in adults. All three patients presented with increased intracranial pressure and papilledema, thus suggesting that these aspects should be investigated in all patients presenting with this clinical pattern. Finally, all our patients began to suffer from migraine. This feature, together with the benign course of the disease, could favor the hypothesis of a migrainous pathophysiology of this syndrome, although this remains a speculative.
BACKGROUND: Transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) is benign and self-limited, with neurologic deficits including sensory disturbance of one body side, aphasia, nausea/vomiting, weakness, decreased vision, homonymous hemianopsia, photophobia. Acute confusional state can rarely occur. Papilledema and intracranial hypertension have also been described. It is a rare entity mainly affecting adults; however, it has been sporadically described in children and adolescents. MAIN FINDINGS: In this clinical observational study, we describe a clinical series of three consecutive pediatric patients being diagnosed with HaNDL after presenting with altered consciousness, papilledema, and increased intracranial pressure. They all recovered without relapses. CONCLUSION: Presentation during childhood and adolescence is rare; the majority of pediatric cases presented with altered consciousness, which is infrequent in HaNDL. This may suggest that in childhood this symptom might be more common than in adults. All three patients presented with increased intracranial pressure and papilledema, thus suggesting that these aspects should be investigated in all patients presenting with this clinical pattern. Finally, all our patients began to suffer from migraine. This feature, together with the benign course of the disease, could favor the hypothesis of a migrainous pathophysiology of this syndrome, although this remains a speculative.