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Stroke is a leading cause of death and long-term disability worldwide, making rapid recognition and treatment essential for improving outcomes. However, not all sudden neurological deficits are caused by cerebrovascular events. Conditions that present with stroke-like symptoms but are not true strokes are known as

stroke mimics

. These can include metabolic disorders, seizures, migraines, infections, functional neurological disorders, and other acute neurological or systemic conditions. Accurate differentiation between true strokes and stroke mimics is critical because misdiagnosis can lead to inappropriate treatments, including unnecessary thrombolysis, delayed care, or missed treatment of the underlying condition [1-4].

Discussion

Stroke mimics account for a significant proportion of patients presenting to emergency departments with suspected acute stroke. Estimates suggest that 20%–30% of suspected stroke cases may ultimately be identified as mimics. The most common causes include seizures, particularly postictal deficits known as Todd’s paresis; migraines with aura; hypoglycemia; infections such as encephalitis or meningitis; and functional neurological disorders. Less common mimics include brain tumors, demyelinating disorders, and electrolyte imbalances [5,6].

The clinical presentation of stroke mimics often overlaps with true ischemic or hemorrhagic strokes, including sudden weakness, speech disturbances, visual deficits, and sensory changes. However, certain features can raise suspicion for a mimic. For example, a history of migraine or seizure, gradual symptom onset, fluctuating neurological deficits, or involvement of non-vascular territories may suggest an alternative diagnosis. Elderly patients, females, and individuals with prior psychiatric or neurological conditions are more likely to present with mimics [7-10].

Differentiating stroke mimics from true strokes relies on a combination of detailed clinical evaluation, laboratory testing, and imaging studies. Neuroimaging, particularly computed tomography (CT) or magnetic resonance imaging (MRI), plays a pivotal role in confirming or excluding cerebrovascular events. Laboratory tests can identify metabolic or infectious causes, while electroencephalography (EEG) may help in seizure-related mimics. Rapid assessment protocols, such as the use of standardized stroke scales (e.g., NIH Stroke Scale), combined with clinical judgment, help reduce misdiagnosis and guide timely intervention.

Conclusion

Stroke mimics represent a significant diagnostic challenge in acute neurology, accounting for a substantial proportion of suspected stroke cases. Accurate identification is essential to avoid inappropriate interventions and ensure that the true underlying condition is promptly addressed. Clinical vigilance, thorough history-taking, targeted investigations, and the judicious use of imaging are key to differentiating mimics from true strokes. As awareness of stroke mimics increases, healthcare systems can improve patient safety, reduce unnecessary interventions, and optimize outcomes for individuals presenting with sudden neurological deficits.

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