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Case Reports in Neurological Medicine
Volume 2013, Article ID 317685, 4 pages
Case Report

Confusional State in HaNDL Syndrome: Case Report and Literature Review

Tufts Medical Center, 800 Washington Street No. 314, Boston, MA 02111, USA

Received 15 June 2013; Accepted 18 July 2013

Academic Editors: P. Berlit and S. T. Gontkovsky

Copyright © 2013 Sarah Nelson. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) is a self-limited condition. Confusional states are uncommonly reported as a clinical manifestation of this syndrome. Here, I report a 76-year-old female who presented with headache, confusion, and agitation with a mild CSF lymphocytosis. Other workup to determine the cause of her altered mental status was otherwise negative. The literature available in the English language on HaNDL syndrome is reviewed, including its history, pathophysiology, possible associations with migraine and stroke, and previously reported cases of confusional states in this syndrome. While HaNDL syndrome has been a described entity since the 1980s, its pathophysiology has yet to be clearly defined.