Stroke Mimics

A stroke mimic is a condition that resembles (mimics) a stroke by causing focal neurological deficits but is later identified not to be a stroke. Commonly encountered stroke mimics include migraine with aura, seizure, vertigo or acute vestibular syndrome, mass lesions, hypoglycemia, and functional neurological disorders. Diagnosing stroke mimics can be challenging since language impairment can limit obtaining a history, and the examination can be similar to an actual stroke. Imaging has limitations: Computed tomography has relatively low sensitivity for detecting acute ischemic stroke, and magnetic resonance imaging has an appreciable false-negative rate for acute ischemic stroke (approximately 6–10%). Stroke mimics are common and sometimes present as emergencies, including prompting the consideration of intravenous thrombolysis. Fortunately, thrombolytic therapy appears safe in patients subsequently found to have a stroke mimic, and current guidelines support thrombolysis if otherwise indicated when it is unclear if a patient has a true acute ischemic stroke or a stroke mimic.