Hemiplegic migraine in childhood: diagnostic and therapeutic aspects

Focal neurologic deficits, particularly hemiplegia, are occasionally observed in the pediatric migrainous population during the headache attack and are often mistaken for other neurologic or neurosurgical conditions. Clues to the correct diagnosis, illustrated by three patients in this report are: (1) rapid spontaneous recovery from the acute neurologic deficit, (2) striking electroencephalographic abnormalities, frequently consisting of focal slow waves during the acute stage, with rapid resolution, (3) significant past history of recurrent episodes, and (4) positive family history of migraine. Review of previously reported cases indicates that cerebral arteriography in the acute stage should be avoided if the clinical syndrome is typical. Preliminary results of prophylactic treatment with propranolol are encouraging; smaller dosage than those previously recommended sometimes can be effective.