Case report When Hemiplegic Migraine Defies Expectations: Diagnostic Complexity in a Rare Genetic Disorder

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.