Not All Patients with Hemiplegia Need Alteplase: A Case of Hemiplegic Migraine

  • Sumeet Yadav St. Joseph Mercy Oakland Hospital, Pontiac, USA
  • Michelle Talukder Ross University School of Medicine, Bridgetown, Barbados
  • Jacky Duong St. Joseph Mercy Oakland Hospital, Pontiac, USA


Hemiplegic migraine, alteplase, CVA, stroke


Hemiplegic migraine (HM) is a rare type of migraine which presents with motor and sensory impairment like a cerebrovascular accident (CVA). We present a case of a 36-year-old female, with a prior CVA treated with alteplase, who presented to the emergency department with stroke-like symptoms with a duration of 1 hour. The NIH Stroke Scale score was 22 at presentation. The patient received alteplase under the supervision of a neurologist after head CT confirmed no bleed. Further work-up revealed no acute or remote ischaemia or infarction. This case demonstrates the importance of a thorough history, intercommunication between health systems and integrated Electronic Medical Records (EMR) for early diagnosis and management of HM.



  • The Genetic and Rare Diseases Information Centre (National Institutes of Health) [Internet]. Hemiplegic migraine [2014]. Available from: (accessed 16 February 2020).

  • Pelzer N, de Vries B, Kamphorst JT, Vijfhuizen LS, Ferrari MD, Haan J, et al. PRRT2 and hemiplegic migraine: a complex association. Neurology 2014;83:288–290.

  • Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013;33:629–808.

  • Thomsen LL, Kirchmann M, Bjornsson A, Stefansson H, Jensen RM, Fasquel AC, et al. The genetic spectrum of a population-based sample of familial hemiplegic migraine. Brain 2007;130:346–356.

  • Pelzer N, Stam AH, Haan J, Ferrari MD, Terwindt GM. Familial and sporadic hemiplegic migraine: diagnosis and treatment. Curr Treat Options Neurol 2013;15:13–27
  • Published: 2020-04-02

    Issue: Vol 7 No 6 (view)

    Section: Articles

    How to cite:
    Yadav S, Talukder M, Duong J. Not All Patients with Hemiplegia Need Alteplase: A Case of Hemiplegic Migraine. EJCRIM 2020;7 doi:10.12890/2020_001585.