A Rare Case of Familial Hemiplegic Migraine with Reversible Motor Weakness and Aphasia

A case presenting with unilateral motor weakness, speech disturbance, and migraine-like headache, accompanied by normal cranial imaging, diagnosed as familial hemiplegic migraine (FHM), is presented to emphasize its rarity and the importance of differential diagnosis. A 44-year-old male patient presented with unilateral weakness in the right arm and leg, lasting approximately one day, along with speech impairment characterized by motor aphasia. The patient reported migraine-like throbbing headaches accompanied by photophobia and phonophobia, with episodes recurring every 3-5 years and triggered by stress. His medical history included thyroid surgery and smoking (20 pack-years), and a family history of similar episodes in the mother and uncle. Neurological examination revealed motor aphasia and right extremity muscle strength of 4/5, but no other pathological findings. Laboratory results, EEG, and cranial magnetic resonance imaging (MRI) were normal. During hospitalization, enoxaparin and lamotrigine were initiated due to prolonged symptoms. The symptoms gradually improved within 2-3 days, with complete resolution observed by the third day. In patients presenting with migraine-like attacks accompanied by unilateral motor weakness and speech disturbances, familial hemiplegic migraine should be considered, especially when imaging and laboratory findings are unremarkable. Recognition of this rare diagnosis is crucial to avoid unnecessary investigations and treatments.