“HANDL SYNDROM E”: DIFFERENTIAL DIAGNOSIS OF HEADACHE IN THUNDER

• DOI: 10.22533/at.ed.1592332230064

• Palavras-chave: Thunderstorm headache; Lymphocytic pleocytosis; Pseudo migraine with lymphocytic pleocytosis.

• Keywords: Thunderstorm headache; Lymphocytic pleocytosis; Pseudo migraine with lymphocytic pleocytosis.

• Abstract:

  Case report: A 27-year-old female patient,
  previously healthy, was hospitalized with a
  thunderclap headache without associated
  acute focal deficit. He denies fever, infectious
  prodromes, recent vaccination or use
  of illicit drugs. On admission, cranial
  tomography and angiotomography were
  performed without alterations. The CSF
  had a xanthochromic aspect, 465 cells/mm
  3 of lymphocytic predominance (93%), 155
  mg/dL proteins, 60mg/dL glucose (97mg/
  dL capillary), in addition to a difference
  of 47 red blood cells between the first and
  second vials.. CSF cultures as well as the
  meningoencephalitis panel were negative.
  Referred to arteriography which did not
  show abnormalities. Serum infectious
  tests including HIV, VDRL, hepatitis and
  herpes virus negative. On the second day of
  hospitalization, the patient had hypoesthesia
  in the right hemiface, diplopia and global
  aphasia with a total duration of 12 hours and
  spontaneous improvement. In the context
  of acute focal deficit, cranial magnetic
  resonance imaging and intracranial arterial
  resonance angiography were performed
  without alterations. After 5 days, a second
  cerebrospinal fluid collection was performed
  and there was an improvement in the protein
  26.6 mg/dL but maintenance of lymphocytic
  pleocytosis - 450 cells (98% lymphocytes).
  No specific treatment was administered.
  The patient had a favorable outcome
  without neurological sequelae, however,
  she maintained episodes of mild migraine
  headache pattern for another 40 days. There
  was no recurrence of new focal deficits.
  
  

   

   

• Número de páginas: 2