It’s all in the History - Hemiplegic Migraine versus Stroke due to Arterial Dissection: A Case Report

A 42-year-old right-handed woman with a history of hypertension and migraine presented with acute onset headache with left-sided weakness.Imaging showed right MCA territory infarction with Internal carotid artery (ICA) dissection with circumferential luminal thickening into the petrous segment.A repeat angiogram five days later revealed new left vertebral artery dissection in V3 and V4 segments.She was managed with dual antiplatelet therapy and her symptoms improved after standard stroke care.We report this case to highlight the importance of taking a good history in patients with previous migraines presenting with acute headaches and focal neurology.