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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Contributors EM was responsible for project concept and design, acquisition of data, manuscript preparation and critical revision of manuscript for intellectual content. JY critically revised the manuscript for intellectual content and was involved in supervision of the project. HDM critically revised the manuscript for intellectual content and was involved in supervision of the project. NA was involved in project concept and design, critical revision of manuscript for intellectual content and project supervision.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Alexandra Sinclair, Birmingham, UK, and Nicholas Davies, London, UK.