Cerebral hemodynamics in the syndrome of pseudomigraine with csf-pleocytosis:a transcranial doppler study

The clinical picture of the pseudomigraine with CSF pleocytosis syndrome is of intermittent headaches, sometimes accompanied by episodes of transient neurological defects and lymphocyte pleocytosis, which occur for a variable length of time, followed by spontaneous resolution. It has been suggested that the cause is immunogenic due to post-infectious activation of the humoral immune system against the leptomeningeal vascular structures, but this hypothesis does not explain the accompanying transient deficit phenomena. We present a study of cerebral hemodynamics using transcranial Doppler in a patient diagnosed as having pseudomigraine with pleocytosis according to current criteria. Our results suggest the presence of cerebral vascular instability and increased vascular reactivity to induced hypocapnia and hypercapnia, similar to that reported in patients with migraine with aura. At no time was significant increase in the average rate of cerebral blood flow detected, comparable to that usually seen in patients with bacterial or viral meningitis. Although the cause cannot be established, from our study it would seem that headache in the pseudomigraine with pleocytosis syndrome is related to cerebral vascular instability and therefore probably to activation of the trigeminal-vascular system. It is possible that the deficit phenomena may also have a similar explanation to that of patients with migraine with aura, that is, a propagated cortical depression. Transcranial Doppler studies may be useful in the diagnosis of pseudomigraine with pleocytosis syndrome.