Background: Congenital Mirror Movements are rare neurodevelopmental disorders characterized by involuntary movements on one side of the body that mirror voluntary movements on the opposite side, most commonly involving the hands. Mild mirror movements may occur during normal early childhood development; however, persistence beyond the expected age suggests abnormal corticospinal tract organization. Congenital forms arise from developmental abnormalities in corticospinal tract decussation, while acquired mirror movements may occur after neurological insults such as stroke, traumatic brain injury, or other central nervous system disorders. In Sub-Saharan Africa, limited clinician awareness and restricted pediatric neurology services contribute to under-recognition and delayed diagnosis. Aim: This narrative review synthesizes current evidence on the epidemiology, genetic mechanisms, pathophysiology, clinical presentation, diagnosis, and management of mirror movements, with particular attention to challenges and practical considerations in Sub-Saharan Africa. Methods: Peer-reviewed literature, including original research articles, case reports, and review papers on mirror movements, was analyzed. Evidence from clinical, neurophysiological, neuroimaging, and genetic studies was examined alongside publications describing pediatric neurology capacity and diagnostic limitations in resource-constrained settings. Data Synthesis: Congenital mirror movements are lifelong, non-progressive conditions frequently associated with mutations in genes such as DCC and RAD51, leading to abnormal corticospinal tract development. Acquired mirror movements arise after neurological injury. Both forms may impair fine motor coordination, and diagnosis in resource-limited settings remains largely clinical. Conclusion: Mirror movements remain under-recognized in Sub-Saharan Africa. Strengthening clinician awareness, incorporating mirror movement assessment into routine neurological examination, promoting early rehabilitation, and improving pediatric neurology capacity are essential to enhance detection, optimize functional outcomes, and reduce disparities in neurological care.