Cortical Spreading Depression Mimicking Ischemic Stroke: A Case Report of Complex Hemiplegic Migraine with Reversible Cortical Magnetic Resonance Imaging Changes.

A 66-year-old man experienced a rare type of migraine called hemiplegic migraine. This migraine caused him to have sudden weakness on his left side and trouble speaking. His symptoms looked similar to a stroke, which made diagnosis difficult. Doctors used imaging tests like CT and MRI to assess his brain. The CT scan showed slight swelling, but no bleeding. The MRI revealed changes in the right side of his brain that suggested temporary swelling of brain cells instead of a stroke. Further tests, including EEG and cerebrospinal fluid analysis, helped clarify his condition. This case highlights how hemiplegic migraine can mimic stroke symptoms, leading to confusion in emergency care. Understanding this connection is crucial for accurate diagnosis and treatment, especially for patients with a history of migraines who show sudden neurological symptoms. Clinical relevance: This case emphasizes the need for careful diagnosis of hemiplegic migraine to avoid misdiagnosis as stroke.