Index Vein in Headache and Neurologic Deficits With CSF Lymphocytosis

The syndrome of headache and neurologic deficits with CSF lymphocytosis (HaNDL) is a self-limited, benign entity, characterized by one or more episodes of severe headache, transient neurologic deficits and lymphocytic pleocytosis in CSF [1]. Functional imaging studies have shown changes in blood flow and brain activity whose temporal and spatial characteristics are similar to those of CSD, mechanism similar to that proposed for migraine with aura [2,3,4]. Recently, was described the clinical utility of a prominent vein named index vein, found on SWI during migraine aura that drains the cortical area responsible for patient´s symptoms [5,6]. Our paper reports a patient with HaNDL and index vein, adding further evidence for spreading depression-like mechanism, similar to that proposed for migraine.