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Symptomatic intracranial hypertension during recovery from the syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HANDL)
  1. Eoin Mulroy1,
  2. Joel Yap2,
  3. Helen Danesh-Meyer2,
  4. Neil Anderson1
  1. 1 Department of Neurology, Auckland Hospital, Auckland, New Zealand
  2. 2 Department of Ophthalmology, Auckland Hospital, Auckland, New Zealand
  1. Correspondence to Dr Eoin Mulroy, Department of Neurology, Auckland Hospital, 2 Park Road, Auckland 1023, New Zealand; EoinM{at}adhb.govt.nz

Abstract

The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HANDL) is rare; it comprises migrainous headaches (generally in headache-naïve people), fluctuating neurological symptoms and cerebrospinal fluid (CSF) lymphocytosis. The syndrome generally runs a benign, self-limiting course over weeks. A small proportion of patients develop intracranial hypertension as a consequence of the illness. Recurrence of headaches or development of visual symptoms following apparent recovery from HANDL should prompt urgent re-evaluation for elevated intracranial pressure. Short-to-medium term management with CSF drainage and acetazolamide may be necessary to prevent visual loss.

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