Purpose <p>Hemisensory syndrome (HS) is a subjective unilateral sensory abnormality that causes reduced sensation and chronic pain, with no additional objective findings, posing a diagnostic challenge. We aimed to determine the rate of neurological diagnosis among patients with hemisensory complaints and identify clinical tools to aid in the diagnosis.</p> Methods <p>A cross-sectional retrospective study was conducted using data collected from 194 patients who presented to the emergency department of a tertiary medical center with hemisensory complaints in 2010–2020. Their medical records were screened for demographic and clinical features and the results of all ancillary examinations.</p> Results <p>A neurological diagnosis was reached for 55/194 patients (28.3%), mainly acute stroke/transient ischemic attack in 24/55 (43.6%), migraine in 14/55 (25.4%), and multiple sclerosis in 13/55 (23.6%). The likelihood of diagnosis was not significantly affected by gender, side involvement, or use of chronic medications. Rate of pyramidal signs and mean triglyceride level were increased in the diagnosis group. Brain magnetic resonance imaging (MRI) most frequently contributed to identifying a diagnosis, demonstrating clinically relevant abnormalities in 58.7% of the diagnosis group (versus 0% in the no-diagnosis group) and in 20.7% of all patients who underwent MRI.</p> Conclusions <p>The diagnostic yield of investigations in patients with HS is relatively low. In approximately one-fourth of cases the etiology is determined. Brain MRI demonstrated the highest diagnostic yield among the neuroimaging modalities evaluated. Additional variables need to be defined to aid clinicians in identifying patients warranting a comprehensive medical examination and in determining which tests to apply.</p>