头痛伴神经功能缺损和脑脊液淋巴细胞增多,以前也被称为假性migraine,具有暂时性神经系统症状和淋巴细胞增多症,是一种自限性综合征,其特征是在脑脊液中淋巴细胞增多的情况下与局灶性神经功能缺损相关的中度至重度头痛。由于它的稀有性,有关头痛伴神经功能缺损和脑脊液淋巴细胞增多的数据很少.因此,我们进行了这篇综述,以分析93例伴有神经功能缺损和脑脊液淋巴细胞增多的头痛患者的相关数据,来描述他们的人口统计特征,临床表现,调查和治疗方案。
我们对通过PubMed和Google学者数据库报告的病例进行了系统回顾,使用首选报告项目进行系统审查和荟萃分析方案。使用的关键词是“头痛伴神经功能缺损和脑脊液淋巴细胞增多”,“头痛伴神经功能缺损和脑脊液淋巴细胞增多综合征”。使用JoannaBriggs研究所关键评估工具评估纳入研究的质量。
我们共分析了93例头痛伴神经功能缺损和脑脊液淋巴细胞增多,发病时平均年龄为28.8岁。70例患者(75.2%)为成人,23(24.7%)属于儿科年龄组。比较这些群体,平均发病年龄为32.5岁和14.3岁,分别。平均随访时间为11.08个月。30%的患者出现头痛复发发作,伴有神经功能缺损和脑脊液淋巴细胞增多症状。据报道,最常见的头痛类型是单侧严重的搏动性发作性头痛。其他相关症状包括感觉障碍(60%)和运动障碍(54.8%)。最不常见的症状是眼球震颤和失写症,每个患者都有一个报告。抗病毒药物是急性期常见的治疗选择(n=23例[23.6%])。而氟桂利嗪是慢性疾病中最常用的药物(n=3例[3.2%])。虽然大多数患者的脑部磁共振成像正常,20例患者有磁共振成像异常,包括(但不限于)非特异性白质病变(8例)和脑膜强化(6例)。最常见的脑电图检查结果包括弥漫性和局灶性减慢。平均脑脊液开放压力为240.5mmH2O。59例(63.4%)患者脑脊液蛋白升高,平均值为114mg/dL。我们队列中的两名患者被发现有脑脊液寡克隆带。
伴有神经功能缺损和脑脊液淋巴细胞增多的头痛倾向于影响男性轻微占优势的年轻人。根据我们的评论,单侧严重的搏动性发作性头痛以及相关的感觉异常和偏瘫是最常见的症状。在伴有神经功能缺损和脑脊液淋巴细胞增多综合征的头痛中可以看到脑脊液开放压力升高。尽早认识到该综合征至关重要。发现抗病毒药物是急性环境中最广泛使用的治疗方法之一。大脑的磁共振成像大多是正常的。弥漫性和局灶性减慢是最常见的脑电图检查结果。在伴有神经功能缺损和脑脊液淋巴细胞增多的头痛中,灌注扫描的脑血流异常并不少见。需要更大样本量的前瞻性研究来验证我们的发现并指导这些患者的临床护理。
Headache with neurologic deficits and cerebrospinal fluid
lymphocytosis, previously also termed pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis, is a self-limiting syndrome characterized by moderate to severe headache associated with focal neurological deficits occurring in the context of lymphocytosis in the cerebrospinal fluid. As a consequence of its rarity, data regarding headache with neurologic deficits and cerebrospinal fluid lymphocytosis is sparse. Therefore, we conducted this
review to analyze data related to 93 patients of headache with neurologic deficits and cerebrospinal fluid lymphocytosis, to characterize their demographics, clinical manifestations, investigations and treatment options.
We performed a systematic
review of cases reported through PubMed and Google scholar database, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Keywords used were \'Headache with Neurologic Deficits and cerebrospinal fluid lymphocytosis\', \'Headache with neurologic deficits and cerebrospinal fluid
lymphocytosis syndrome\'. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Tool.
We analyzed a total of 93 cases of headache with neurologic deficits and cerebrospinal fluid lymphocytosis with a mean age of 28.8 years at onset. Seventy patients (75.2%) were adults, while 23 (24.7%) belonged to the pediatric age group. Comparing these groups, mean age at onset was 32.5 years and 14.3 years, respectively. The average duration of follow-up was 11.08 months. Thirty percent of patients experienced relapsing episodes of headache with neurologic deficits and cerebrospinal fluid lymphocytosis symptoms. The most common type of headache reported was unilateral severe throbbing episodic headache. Other associated symptoms included sensory deficit (60%) and motor deficits (54.8%). The least common symptoms were nystagmus and agraphia, which were reported in one patient each. Antiviral agents were a common treatment option in the acute phase (n = 23 patients [23.6%]), while Flunarizine was the most commonly used agent in the chronic setting (n = 3 patients [3.2%]). While most of the patients had normal brain magnetic resonance imaging, 20 patients had magnetic resonance imaging abnormalities, including (but not limited to) non-specific white matter lesions (eight patients) and meningeal enhancement (six patients). The most common electroencephalographic findings included diffuse and focal slowing. The mean cerebrospinal fluid opening-pressure was 240.5 mmH2O. Cerebrospinal fluid protein was elevated in 59 (63.4%) patients, with a mean value of 114 mg/dL. Two patients in our cohort were found to have cerebrospinal fluid oligoclonal bands.
Headache with neurologic deficits and cerebrospinal fluid lymphocytosis tends to affect young individuals with a slight male predominance. Unilateral severe throbbing episodic headache with associated hemi-paresthesia and hemiparesis were the most common symptoms based on our
review. Elevated cerebrospinal fluid opening-pressure can be seen in headache with neurologic deficits and cerebrospinal fluid lymphocytosis syndrome. Early recognition of the syndrome is paramount. Antivirals were found to be among the most widely used treatments in the acute setting. Magnetic resonance imaging of the brain is mostly normal. Diffuse and focal slowing were among the most common electroencephalographic findings. Cerebral flow abnormalities on perfusion scans are not uncommon in headache with neurologic deficits and cerebrospinal fluid lymphocytosis. Prospective studies with a larger sample size are needed to validate our findings and guide the clinical care of these patients.