This case describes a diagnostically challenging presentation of familial hemiplegic migraine, combining prolonged hemiparesis, severe headaches, altered consciousness and fever. Such a constellation initially suggested acute stroke, encephalitis, or status epilepticus. It underscores the wide phenotypic variability of familial hemiplegic migraine and the risk of misdiagnosis in emergency settings. A precise clinical history and targeted genetic testing (CACNA1A, ATP1A2, SCN1A and PRRT2) proved essential for identifying this rare condition. Early recognition enabled appropriate management and avoided unnecessary interventions.
Goossens et al. (Wed,) studied this question.