Hemiplegic migraine is a variant of migraine that includes a component of fully reversible unilateral motor weakness (aura), which typically lasts from 5 minutes to 72 hours. Sporadic hemiplegic migraine is a diagnosis of exclusion because 2 similar episodes are required to make the diagnosis. Diagnosis can be challenging because symptoms mimic arterial ischemic stroke and other entities. Atypical cases may have severe protracted symptoms, and, in children, a history may be elusive. Awareness of neuroimaging findings associated with hemiplegic migraine is important to distinguish from processes with similar clinical presentations associated with irreversible deficits. By using a multi-institutional series of children and adolescents supported by an extensive literature review, we provided a pictorial essay of the spectrum of imaging findings of hemiplegic migraine in the pediatric population. Learning Objective: Recognize the spectrum of imaging findings in patients with hemiplegic migraine seen acutely and in those with delayed presentation. Recognize features that distinguish hemiplegic migraine from arterial ischemic stroke and other differential diagnoses.
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