“HANDL SYNDROM E” DIFFERENTIAL DIAGNOSIS OF HEADACHE IN THUNDER (Atena Editora)

Abstract

Case report: A 27-year-old female patient,previously healthy, was hospitalized with athunderclap headache without associatedacute focal deficit. He denies fever, infectiousprodromes, recent vaccination or useof illicit drugs. On admission, cranialtomography and angiotomography wereperformed without alterations. The CSFhad a xanthochromic aspect, 465 cells/mm3 of lymphocytic predominance (93%), 155mg/dL proteins, 60mg/dL glucose (97mg/dL capillary), in addition to a differenceof 47 red blood cells between the first andsecond vials.. CSF cultures as well as themeningoencephalitis panel were negative.Referred to arteriography which did notshow abnormalities. Serum infectioustests including HIV, VDRL, hepatitis andherpes virus negative. On the second day ofhospitalization, the patient had hypoesthesiain the right hemiface, diplopia and globalaphasia with a total duration of 12 hours andspontaneous improvement. In the contextof acute focal deficit, cranial magneticresonance imaging and intracranial arterialresonance angiography were performedwithout alterations. After 5 days, a secondcerebrospinal fluid collection was performedand there was an improvement in the protein26.6 mg/dL but maintenance of lymphocyticpleocytosis - 450 cells (98% lymphocytes).No specific treatment was administered.The patient had a favorable outcomewithout neurological sequelae, however,she maintained episodes of mild migraineheadache pattern for another 40 days. Therewas no recurrence of new focal deficits.