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8-year-old boy presenting with acute-onset left hemiplegia. Stroke protocol MRI without evidence of large vessel occlusion or high grade stenosis on MR angiogram (a), acute infarction on DWI (b), or signal abnormality on FLAIR (c). ASL demonstrates marked CBF reduction throughout the right hemisphere, including the right MCA territory. Based on clinical presentation and ASL findings, diagnosis of complex hemiplegic migraine was made. The patient recovered without intervention.
