Not All Patients with Hemiplegia Need Alteplase: A Case of Hemiplegic Migraine

Hemiplegic migraine (HM) is a rare type of migraine which presents with motor and sensory impairment like a cerebrovascular accident (CVA). We present a case of a 36-year-old female, with a prior CVA treated with alteplase, who presented to the emergency department with stroke-like symptoms with a duration of 1 hour. The NIH Stroke Scale score was 22 at presentation. The patient received alteplase under the supervision of a neurologist after head CT confirmed no bleed. Further work-up revealed no acute or remote ischaemia or infarction. This case demonstrates the importance of a thorough history, intercommunication between health systems and integrated Electronic Medical Records (EMR) for early diagnosis and management of HM. LEARNING POINTS: Hemiplegic migraine (HM) is difficult to diagnose and can mimic stroke, resulting in administration of dangerous medications such as thrombolytics/alteplase. A thorough history, intercommunication between health systems and integrated EMR are essential for early diagnosis and management of HM.