Clinical, neuroimaging and electroencephalographic differences between pediatric and adult HaNDL: a systematic review and pooled individual patient analysis.
Gonçalo Cabral, Maria Brás Monteiro, Miguel Viana Baptista
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In 30 seconds
This PRISMA 2020-guided systematic review and pooled individual patient analysis compared clinical and ancillary findings in pediatric and adult patients with HaNDL, a self-limited headache syndrome with cerebrospinal fluid lymphocytosis. It included 194 published cases: 159 adults and 35 children. Most clinical, cerebrospinal fluid, neuroimaging, and electroencephalographic features were similar across age groups. Optic disc edema was more frequent in pediatric patients (43.8% vs. 5.7%, p = 0.002); pediatric patients were also more often male (66.7% vs. 40.4%, p = 0.016).
Key findings
- Optic disc edema was more frequent in pediatric than adult patients (43.8% vs. 5.7%, p = 0.002).
- The proportion of males was higher among pediatric patients (66.7% vs. 40.4%, p = 0.016).
- Most clinical, cerebrospinal fluid, neuroimaging, and electroencephalographic findings were comparable between age groups.
- Altered mental status was reported more often in pediatric patients, but the difference was not statistically significant.
Why it matters
The broadly shared presentation supports viewing HaNDL as one syndrome across the lifespan, while age-associated features may help clinicians recognize it. In children, optic disc edema and possible altered mental status are relevant to assessment, but HaNDL remains a diagnosis of exclusion and high-risk alternatives should be reasonably excluded.
What to keep in mind
The analysis pooled published cases, so its findings depend on available case reports and records; the pediatric group was smaller than the adult group.