{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:56Z","timestamp":1756339556991,"version":"3.44.0"},"reference-count":22,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,6,12]]},"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:p>Headache and neurological deficits with cerebrospinal fluid (CSF) lymphocytosis (HaNDL) is a rare condition characterised by recurrent episodes of headache and transient neurological deficits. This case report presents a young patient initially diagnosed with hemiplegic migraine, having a normal brain CT, with focal cerebral perfusion mismatch not restricted to a single vascular territory on CT angiography. Brain MRI revealed a cytotoxic lesion of the splenium in the corpus callosum (CLOCC), a feature also reported in migraine. However, recurrent headaches with neurological deficits prompted further investigations with CSF analysis and brain MRI, confirming HaNDL and demonstrating reversibility of CLOCC. Recognising HaNDL as a differential diagnosis is essential in patients with recurrent headaches with focal neurological deficits, given the differences in therapeutic approach. The relationship between migraine and HaNDL is not fully understood, but they may share a pathophysiological link. Awareness of this is crucial for accurate diagnosis.<\/jats:p>","DOI":"10.1136\/bcr-2023-259463","type":"journal-article","created":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T22:10:28Z","timestamp":1721772628000},"page":"e259463","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome with reversible cytotoxic lesion of the corpus callosum (CLOCC) on MRI of the brain"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5526-7405","authenticated-orcid":false,"given":"Phuong Hien Duc","family":"Nguyen","sequence":"first","affiliation":[{"name":"Nuclear Medicine and PET, Nepean Hospital, Kingswood, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0878-0120","authenticated-orcid":false,"given":"Gi Tae","family":"Kwon","sequence":"additional","affiliation":[{"name":"Neurology, Nepean Hospital, Kingswood, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Ruhul","family":"Amin","sequence":"additional","affiliation":[{"name":"Neurology, Nepean Hospital, Kingswood, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,7,23]]},"reference":[{"key":"2025082710581520000_17.7.e259463.1","unstructured":"The International Classification of Headache Disorders (ICHD-3) . 7.3.5 syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL). ICHD-3. n.d. Available: https:\/\/ichd-3.org\/7-headache-attributed-to-non-vascular-intracranial-disorder\/7-3-headache-attributed-to-non-infectious-inflammatory-disease\/7-3-5-syndrome-of-transient-headache-and-neurological-deficits-with-cerebrospinal-fluid-lymphocytosis-handl\/"},{"key":"2025082710581520000_17.7.e259463.2","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/0883073818811546","article-title":"Handl syndrome: case report and literature review","volume":"34","author":"Armstrong-Javors","year":"2019","journal-title":"J Child Neurol"},{"key":"2025082710581520000_17.7.e259463.3","doi-asserted-by":"crossref","first-page":"3331024231157694","DOI":"10.1177\/03331024231157694","article-title":"Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis syndrome: a comprehensive systematic review of 93 patients from 57 studies","volume":"43","author":"Al-Chalabi","year":"2023","journal-title":"Cephalalgia"},{"key":"2025082710581520000_17.7.e259463.4","doi-asserted-by":"crossref","DOI":"10.1186\/s40001-022-00815-8","article-title":"Handl syndrome: a reversible cerebral vasoconstriction triggered by an infection? A case report and a case-based review","volume":"27","author":"Fiamingo","year":"2022","journal-title":"Eur J Med Res"},{"key":"2025082710581520000_17.7.e259463.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2982.2009.01950.x"},{"key":"2025082710581520000_17.7.e259463.6","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1159\/000259619","article-title":"Acute perfusion MR imaging in a HaNDL-like syndrome","volume":"29","author":"Vallet","year":"2010","journal-title":"Cerebrovasc Dis"},{"key":"2025082710581520000_17.7.e259463.7","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/head.13768","article-title":"Reversible lesion of the corpus callosum in a patient with migraine with aura: a case study","volume":"60","author":"Lewis","year":"2020","journal-title":"Headache"},{"key":"2025082710581520000_17.7.e259463.8","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1007\/s00508-011-0113-x","article-title":"Transient restricted diffusion in the splenium of the corpus callosum in migraine with aura","volume":"124","author":"Agarwal","year":"2012","journal-title":"Wien Klin Wochenschr"},{"key":"2025082710581520000_17.7.e259463.9","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/NRL.0b013e31821733c2","article-title":"Reversible Splenial lesion of the corpus callosum in migraine with aura","volume":"17","author":"Lin","year":"2011","journal-title":"Neurologist"},{"key":"2025082710581520000_17.7.e259463.10","article-title":"Hemiplegic migraine as the initial presentation of biopsy positive cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy","volume":"10","author":"Rossi","year":"2018","journal-title":"Cureus"},{"key":"2025082710581520000_17.7.e259463.11","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.61.9.1366"},{"key":"2025082710581520000_17.7.e259463.12","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2017160085"},{"key":"2025082710581520000_17.7.e259463.13","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1007\/s13760-022-01890-8","article-title":"A cytotoxic lesion of the corpus callosum (CLOCC) in a patient with headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL): a hint for pathophysiology","volume":"123","author":"\u00d6zdemir","year":"2023","journal-title":"Acta Neurol Belg"},{"key":"2025082710581520000_17.7.e259463.14","doi-asserted-by":"publisher","DOI":"10.1007\/s13760-012-0018-0"},{"key":"2025082710581520000_17.7.e259463.15","unstructured":"CARE case report guidelines. n.d. Available: https:\/\/www.care-statement.org\/"},{"key":"2025082710581520000_17.7.e259463.16","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1177\/23969873221114256","article-title":"Computed tomographic perfusion abnormalities in acute migraine with aura: characteristics and comparison with transient ischemic attack","volume":"7","author":"Strambo","year":"2022","journal-title":"Eur Stroke J"},{"key":"2025082710581520000_17.7.e259463.17","doi-asserted-by":"publisher","DOI":"10.1177\/0333102414523339"},{"key":"2025082710581520000_17.7.e259463.18","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.nic.2019.01.009","article-title":"Advanced imaging in the evaluation of migraine headaches","volume":"29","author":"Ellingson","year":"2019","journal-title":"Neuroimaging Clin N Am"},{"key":"2025082710581520000_17.7.e259463.19","doi-asserted-by":"publisher","DOI":"10.2147\/jpr.s209485"},{"key":"2025082710581520000_17.7.e259463.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)06711-3"},{"key":"2025082710581520000_17.7.e259463.21","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1111\/j.1526-4610.2006.00631.x","article-title":"Patterns of diagnosis and acute and preventive treatment for migraine in the United States: results from the American migraine prevalence and prevention study","volume":"47","author":"Diamond","year":"2007","journal-title":"Headache"},{"key":"2025082710581520000_17.7.e259463.22","doi-asserted-by":"crossref","first-page":"52","DOI":"10.4274\/npa.y7228","article-title":"Beyin Omurilik S\u0131v\u0131s\u0131 Lenfositozu ve Ge\u00e7ici N\u00f6rolojik Bulgular\u0131n E\u015flik Etti\u011fi Ba\u015f A\u011fr\u0131s\u0131 Sendromu","volume":"50","author":"\u00c7oban","year":"2013","journal-title":"N\u00f6ro Psikiyatri Ar\u015fivi"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-259463","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:58:26Z","timestamp":1756317506000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-259463"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":22,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7,23]]},"published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1136\/bcr-2023-259463"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-259463","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,7]]}}}