Brain, Vol 120, Issue 7 1105-1113, Copyright © 1997 by Oxford University Press
F Gomez-Aranda, F Canadillas, JF Marti-Masso, E Diez-Tejedor, PJ Serrano, R Leira, M Gracia and J Pascual
This is the first large series, comprising 50 patients who suffered a total
of 164 episodes, of pseudomigraine with temporary neurological symptoms and
lymphocytic pleocytosis (PMP syndrome). Onset of PMP was between the ages
of 14 and 39 years and was most frequent in males (68%). Eight males (24%)
and five females (31%) had a personal history of migraine. One-quarter had
had a viral-like illness up to 3 weeks prior to the onset of the syndrome.
The clinical picture consisted of one to 12 episodes of changing variable
neurological deficits accompanied by moderate-to-severe headache and
occasionally fever. The headaches were described as predominantly throbbing
and bilateral with variable duration (mean, 19 h). The mean duration of the
transient neurological deficits was 5 h. Sensory symptoms were most common
(78% of episodes), followed by aphasic (66%) and motor (56%) symptoms.
Visual symptoms appeared in only 12% of episodes. The most frequent
combinations were motor aphasia plus sensory and motor right hemibody
symptoms (19% of episodes), motor aphasia plus right sensory symptoms (10%)
and isolated right (9%) or left (9%) sensory symptoms. All patients were
asymptomatic between episodes and following the symptomatic period (maximum
duration 49 days). Lymphocytic pleocytosis ranged from 10 to 760
lymphocytic cells/mm3 CSF (mean, 199). In CSF, protein was increased in 96%
of patients, IgG was normal in 80% of cases and oligoclonal bands were not
found. Adensoine deaminase values were slightly above normal in two out of
16 patients tested. Extensive microbiological determinations, including
viral HIV and borrelia serologies, were negative. Brain CT and MRI were
always within normal limits, while EEG frequently showed focal slowing.
Conventional cranial angiography was performed on 12 patients. In only one
were there abnormalities suggestive of localized vascular inflammation,
coincident with the focal neurological symptoms. Two patients developed PMP
symptoms immediately after angiography. SPECT, performed on only three
patients in the symptomatic period, revealed focal areas of decreased
uptake consistent with the clinical symptoms. PMP aetiology remains a
mystery; chronic arachnoiditis, viral meningoencephalitis or migraine are
not plausible aetiological explanations. Because a number of patients had
had a prodromic viral-like illness, we hypothesize here that such a viral
infection could activate the immune system, thereby producing antibodies
that would induce an aseptic inflammation of the leptomeningeal
vasculature, possibly accounting for this clinical picture.
ARTICLES
Pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis. A report of 50 cases
Department of Neurology, University Hospital Virgen del Rocio, Sevilla, Spain.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  H Emond, H Schnorf, C Poloni, S Vulliemoz, and P. Lalive Syndrome of Transient Headache and Neurological Deficits with CSF Lymphocytosis (HaNDL) Associated with Recent Human Herpesvirus-6 Infection Cephalalgia, April 1, 2009; 29(4): 487 - 491. [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Pettersen, R. I. Aviv, S. E. Black, A. J. Fox, A. Lim, and B. J. Murray Global Hemispheric CT Hypoperfusion May Differentiate Headache With Associated Neurological Deficits and Lymphocytosis From Acute Stroke Stroke, February 1, 2008; 39(2): 492 - 493. [Full Text] [PDF]
|
|
|
|
|
|
A Fumal, M Vandenheede, G Coppola, L Di Clemente, J Jacquart, P Gerard, A. de Noordhout, and J Schoenen The Syndrome of Transient Headache with Neurological Deficits and CSF Lymphocytosis (HaNDL): Electrophysiological Findings Suggesting a Migrainous Pathophysiology Cephalalgia, September 1, 2005; 25(9): 754 - 758. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Safier and G. Alper A Child with Transient Neurologic Deficits and Headache Associated with Cerebrospinal Fluid Pleocytosis J Child Neurol, May 1, 2005; 20(5): 439 - 441. [Abstract] [PDF]
|
|
|
|
|
|
S Oberndorfer, C Wober, C Nasel, S Asenbaum, H Lahrmann, B Fueger, and W Grisold Familial Hemiplegic Migraine: Follow-up Findings of Diffusion-Weighted Magnetic Resonance Imaging (MRI), Perfusion-MRI and [99mTc] HMPAO-SPECT in a Patient with Prolonged Hemiplegic Aura Cephalalgia, July 1, 2004; 24(7): 533 - 539. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T Sand Electroencephalography in Migraine: A Review with Focus on Quantitative Electroencephalography and the Migraine Vs. Epilepsy Relationship Cephalalgia, May 1, 2003; 23(1_suppl): 5 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.N. K. Murthy and M. E. Cohen Pseudomigraine With Prolonged Aphasia in a Child With Cranial Irradiation for Medulloblastoma J Child Neurol, February 1, 2002; 17(2): 134 - 138. [Abstract] [PDF]
|
|
|
|
 |
|
 G. Moris and J. C. Garcia-Monco The Challenge of Drug-Induced Aseptic Meningitis Arch Intern Med, June 14, 1999; 159(11): 1185 - 1194. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Masjuan, J. Buisan, T. Frutos, C. Quereda, and J. C. Alvarez-Cermeno The not so benign syndrome of transient headache with neurologic deficits and CSF lymphocytosis Neurology, July 1, 1998; 51(1): 313 - 314. [Full Text] [PDF]
|
|