{ "schemaVersion": 2, "eyebrow": "Vascular Neurology", "title": "Stroke Mimics", "summary": "Acute focal deficits require parallel stroke treatment readiness and rapid mimic recognition. Use bedside pattern analysis, glucose testing, CT-based vascular imaging, and selectively MRI or EEG to identify seizure, migraine, metabolic, functional, vestibular, inflammatory, venous, and structural alternatives without delaying reperfusion decisions.", "seoDescription": "Point-of-care evaluation of stroke mimics: bedside discriminators, emergency imaging, metabolic testing, and when MRI or EEG changes acute management.", "clinicalQuestion": "How should physicians rapidly distinguish common stroke mimics from acute ischemic stroke without delaying reperfusion therapy?", "specialty": "Neurology", "audience": "U.S. physicians and medical trainees", "tags": [ "stroke mimics", "acute stroke evaluation", "seizure", "Todd paralysis", "hemiplegic migraine", "hypoglycemia", "functional neurologic disorder", "MRI DWI", "CT angiography" ], "keyTakeaways": [ "Treat abrupt focal deficits as presumed stroke while obtaining point-of-care glucose and noncontrast CT; thrombolytic decisions should not wait for routine laboratory results unless a result is needed to determine eligibility.[3]", "Seizure, peripheral vestibular dysfunction, toxic-metabolic disorders, functional neurologic disorder, and migraine account for a large share of stroke mimics; no single clinical feature reliably excludes ischemia.[9]", "CTA demonstrating an intracranial large-vessel occlusion and concordant perfusion abnormality strongly supports ischemic stroke, whereas normal CT, CTA, and CTP should prompt reconsideration of a mimic but do not exclude small lacunar or posterior circulation infarction.[17]", "MRI with diffusion-weighted imaging is the most sensitive modality for early ischemic change and can clarify mimics when available without disrupting time-critical stroke care.[16][17]", "A credible mimic diagnosis should not automatically preclude IV thrombolysis when disabling ischemic stroke remains plausible; guideline framing emphasizes that the small risk of treating a mimic is outweighed by potential benefit in true ischemic stroke.[4]" ], "sections": [ { "id": "first-minutes", "eyebrow": "Emergency Triage", "heading": "Manage the initial presentation as possible ischemic stroke", "intro": "The first objective is to identify reversible mimics and reperfusion candidates in parallel.", "paragraphs": [ "Record last-known-well time, characterize the deficit as negative versus positive, perform a focused neurologic examination, and obtain immediate glucose. Hypoglycemia can produce focal deficits, depressed consciousness, and seizures; rapidly correct a low glucose concentration while continuing the stroke evaluation if a focal deficit persists.[3]", "Obtain noncontrast head CT to exclude hemorrhage and, when an endovascular target is possible, CTA of the head and neck. A CT-based acute stroke protocol commonly includes noncontrast CT, CTA of brain and neck vessels, and CTP when available.[16] CTA/CTP findings must be interpreted against the examination: a normal CTA and CTP raise the probability of a mimic, but CTP can be normal in small lacunar infarction and can be nonspecific in mimics.[17]", "Send CBC with platelet count, electrolytes, renal function, PT/INR, and aPTT while imaging proceeds. Do not delay thrombolytic therapy awaiting routine results; prioritize platelet count and PT/INR when warfarin use or liver dysfunction makes them directly relevant to treatment eligibility.[3]" ], "bullets": [ "Escalate immediately for emergency imaging when thrombolysis or thrombectomy may be indicated, the patient takes an anticoagulant, has a bleeding tendency, has GCS below 13, has progressive or fluctuating symptoms, or presents with papilledema, meningismus, fever, or severe headache at onset.[22]", "Use a medication, intoxication, and systemic illness history to identify toxic-metabolic encephalopathy, drug-related delirium, hyponatremia, sepsis, or hypoglycemia that may coexist with or mimic stroke.[8][9]" ], "subsections": [], "table": { "caption": "Immediate tests and their decision implications in suspected stroke mimic presentations.[3][16][17]", "columns": [ "Action", "Result or pattern", "Interpretation and next step" ], "rows": [ [ "Point-of-care glucose", "Low glucose with focal signs or reduced consciousness", "Correct promptly; reassess deficit, but continue stroke imaging if focal findings persist.[3]" ], [ "Noncontrast head CT", "Hemorrhage or alternative structural lesion", "Redirect from ischemic reperfusion pathway and manage the identified lesion.[16]" ], [ "CTA head and neck", "Intracranial large-vessel occlusion", "Supports acute ischemic stroke and prompts thrombectomy assessment when clinically appropriate.[17]" ], [ "CTP", "Perfusion abnormality concordant with examination and CTA", "Supports ischemic pathophysiology; interpret with CTA and clinical territory.[15][17]" ], [ "CT, CTA, and CTP", "All normal", "Reconsider mimic and obtain MRI when the diagnosis remains uncertain; do not dismiss small lacunar infarction solely on this basis.[17]" ], [ "MRI DWI", "Acute ischemic lesion", "Confirms tissue infarction and informs etiologic stroke evaluation.[17]" ] ] } }, { "id": "bedside-patterns", "eyebrow": "Clinical Branching", "heading": "Use symptom evolution and examination to prioritize the mimic differential", "intro": "History and examination shift probability but do not replace vascular imaging in disabling acute deficits.", "paragraphs": [ "Positive phenomena—witnessed convulsions, recurrent stereotyped sensory or motor events, visual aura, or spreading symptoms—favor seizure or migraine over an abrupt negative deficit. Ask specifically about seizure history, witnessed ictal activity, postictal confusion, prior similar migrainous episodes, aura preceding headache, and the sequence of symptom onset.[3]", "A deficit that does not conform to a vascular territory, lacks expected cranial nerve findings, or changes with distraction raises concern for functional neurologic disorder. Hoover sign is one of the few named bedside maneuvers identified as useful in the mimic differential; an internally inconsistent examination should trigger careful re-examination rather than premature diagnostic closure.[3][9]", "In acute vestibular presentations, use the HINTS examination only in the appropriate acute vestibular syndrome and only when performed by clinicians skilled in the maneuver. HINTS is among the limited clinical approaches identified in the literature as useful for distinguishing mimics, but posterior circulation ischemia remains an imaging-sensitive diagnostic problem.[9][17]" ], "bullets": [ "Features that increase the pretest probability of a mimic include younger age, fewer vascular risk factors, female sex, lower or near-normal blood pressure, and less severe deficits; these are population associations, not exclusion criteria for stroke.[9]", "Common mimic categories include peripheral vestibular dysfunction, toxic-metabolic disorders, seizures, functional disorders, and migraine.[9]", "Other high-consequence mimics requiring imaging-directed consideration include cerebral venous thrombosis, posterior reversible encephalopathy syndrome, neoplasm, inflammatory disease, and traumatic lesions.[15][16]" ], "subsections": [ { "heading": "Transient deficits are not automatically mimics", "paragraphs": [ "If focal symptoms resolve, assess for TIA as well as mimics. TIA is defined by focal cerebral, spinal, or retinal ischemic dysfunction without acute infarction; urgently obtain brain imaging and vascular imaging. Carotid duplex can screen for disease, but CTA or MRA is used to confirm arterial stenosis greater than 50%.[21]" ], "bullets": [ "Obtain CBC, metabolic testing, coagulation studies, lipid panel, fasting glucose, and HbA1c during TIA-oriented evaluation; obtain a urine drug screen selectively when exposure could explain the event.[21]" ] } ], "table": { "caption": "High-yield clinical patterns that redirect the acute differential while preserving stroke vigilance.[3][9][15][16]", "columns": [ "Etiologic branch", "Discriminating pattern", "Test or next action" ], "rows": [ [ "Seizure with postictal deficit", "Witnessed seizure, prior seizures, postictal period; deficits may persist after ictus.[3]", "Obtain MRI when diagnosis remains uncertain; consider EEG when ongoing ictal activity is suspected clinically." ], [ "Migraine aura", "Prior similar events, aura preceding headache, and headache history.[3]", "Do not rely on history alone when onset is abrupt or deficits are disabling; complete acute stroke imaging." ], [ "Hypoglycemia", "Diabetes history, low serum glucose, decreased consciousness or focal deficit.[3]", "Rapidly correct glucose and reassess; persistent deficits require stroke evaluation." ], [ "Functional neurologic disorder", "Inconsistent findings, nonvascular distribution, absent expected cranial nerve findings, or positive Hoover sign.[3][9]", "Re-examine and exclude ischemia with time-appropriate imaging before assigning a functional diagnosis." ], [ "PRES or venous thrombosis", "Headache, encephalopathy, severe hypertension, seizures, or atypical imaging distribution; these are recognized stroke mimics.[3][15][16]", "Use MRI-based characterization when CT-based evaluation does not establish the cause." ] ] } }, { "id": "imaging-and-electrophysiology", "eyebrow": "Diagnostic Escalation", "heading": "Select MRI and EEG when CT-based evaluation does not resolve the mismatch", "intro": "Advanced testing is most useful when examination, vascular imaging, and perfusion findings are discordant.", "paragraphs": [ "Use MRI with DWI when CT/CTA/CTP is unrevealing or discordant with a persisting focal deficit, when symptoms are transient, or when a structural, inflammatory, neoplastic, venous, or seizure-related alternative remains plausible. MRI has greater sensitivity for early ischemic changes and is better than CT at identifying several infarct types and mimics, but longer acquisition time and safety screening can limit emergency use.[16][17]", "Do not interpret a negative MRI as absolute exclusion of stroke. Small infarctions, particularly brainstem lesions, may be missed on routine MRI; nevertheless, absent MRI lesions should increase concern for a mimic when imaging and clinical evolution remain incompatible with vascular ischemia.[17]", "In suspected seizure-related deficits, recognize that ictal hyperperfusion may be visible with arterial spin labeling, while seizure-related DWI hyperintensity with low ADC can resemble infarction. These seizure-associated MRI abnormalities are usually reversible, so correlate lesion distribution with clinical semiology, vascular imaging, and subsequent imaging rather than diagnosing ischemic stroke from DWI restriction alone.[19]" ], "bullets": [ "MRI-first pathways can reduce treatment of stroke mimics with IV thrombolysis and reduce repeat imaging, but MRI availability and workflow must not compromise timely treatment of true stroke.[1][16]", "CTP core and penumbra estimates use common thresholds of relative CBF below 30% for core and Tmax greater than 6 seconds for hypoperfused tissue; interpret these maps with CTA because artifacts and nonvascular physiology can mislead.[15][17]" ], "subsections": [], "table": { "caption": "Imaging interpretation pitfalls in stroke mimic assessment.[15][17][19]", "columns": [ "Finding", "Potential interpretation", "Decision safeguard" ], "rows": [ [ "Normal CT, CTA, and CTP", "Mimic becomes more likely.[17]", "Maintain concern for small lacunar infarction and correlate with examination; obtain MRI when it will change management.[17]" ], [ "DWI restriction with low ADC", "Acute infarction or seizure-related cytotoxic edema.[19]", "Assess vascular-territory concordance, CTA, perfusion pattern, clinical seizure evidence, and reversibility on follow-up imaging.[19]" ], [ "Focal ictal hyperperfusion on ASL", "Active seizure focus may cause regional hyperperfusion.[19]", "Correlate with electroclinical evidence rather than treating hyperperfusion as arterial reperfusion alone.[19]" ], [ "CTA large-vessel occlusion with concordant perfusion deficit", "Acute ischemic stroke is strongly supported.[17]", "Proceed with reperfusion pathway assessment; do not defer for mimic testing that will not change immediate treatment." ] ] } }, { "id": "treatment-decisions", "eyebrow": "Treatment Threshold", "heading": "Avoid diagnostic delay when disabling ischemic stroke remains plausible", "intro": "The treatment decision depends on residual probability of ischemia, disability, timing, and imaging—not on certainty alone.", "paragraphs": [ "Do not withhold IV thrombolysis solely because a common mimic is possible when the patient has a potentially disabling acute ischemic deficit and no contraindication. Current guideline language states that the very small risk of treating a stroke mimic is likely outweighed by the potential major benefit of IV thrombolysis in true ischemic stroke.[4]", "If CTA identifies a thrombectomy-eligible occlusion, transfer or activate the endovascular pathway without waiting for MRI confirmation of infarction. Thrombectomy should be offered as soon as possible and within 6 hours of symptom onset for eligible acute ischemic stroke, with IV thrombolysis given when not contraindicated and within its applicable treatment window.[22]", "Once a mimic is established, treat the underlying process rather than labeling the presentation as a benign false alarm. Hypoglycemia requires prompt correction; suspected ongoing seizure requires electroclinical assessment; severe hypertension with encephalopathy and cerebral edema redirects care toward hypertensive encephalopathy/PRES evaluation; and structural, venous, neoplastic, or inflammatory imaging findings require cause-specific neurologic management.[3][15][16]" ], "bullets": [ "Maintain post-thrombolysis monitoring capability, immediate access to re-imaging, and staff trained to recognize treatment complications whenever thrombolysis is delivered.[22]", "Document the specific rationale for a mimic diagnosis: the supporting clinical pattern, glucose and laboratory findings, vascular imaging, MRI result when obtained, and response to targeted treatment." ], "subsections": [ { "heading": "When to re-open the stroke diagnosis", "paragraphs": [ "Reassess a presumed mimic if the deficit persists, evolves into a vascular pattern, recurs without the expected trigger, or is discordant with the proposed diagnosis. Small infarcts and posterior circulation lesions can escape initial CT-based evaluation and, less commonly, routine MRI; repeat neurologic examination and MRI-based reassessment may be decisive.[17]" ], "bullets": [] } ], "table": { "caption": "Treatment posture when stroke and mimic remain competing diagnoses.[4][17][22]", "columns": [ "Clinical state", "Immediate posture", "Do not do" ], "rows": [ [ "Disabling acute focal deficit; ischemic stroke remains plausible", "Complete CT-based exclusion of hemorrhage and eligibility assessment while proceeding rapidly toward reperfusion treatment.[4][22]", "Do not delay time-sensitive treatment for MRI solely to obtain diagnostic certainty.[4][16]" ], [ "LVO on CTA with concordant clinical syndrome", "Activate thrombectomy assessment and give IV thrombolysis when eligible within the relevant window.[22]", "Do not wait for a mimic workup that cannot supersede the vascular finding in time." ], [ "Corrected hypoglycemia with complete resolution and no residual focal deficit", "Treat the metabolic event and reassess for an alternative cerebrovascular indication based on presentation.[3]", "Do not assume correction excludes concomitant stroke if focal findings persist or recur.[3]" ], [ "Imaging and examination favor mimic but diagnostic discordance persists", "Obtain MRI DWI and targeted testing such as EEG when seizure remains plausible.[17][19]", "Do not close the diagnosis based on a single normal CT or CTP study.[17]" ] ] } }, { "id": "documentation-and-follow-up", "eyebrow": "Disposition", "heading": "Close the loop after the acute exclusion or confirmation pathway", "intro": "Disposition should match the residual probability of ischemia and the acuity of the identified alternative.", "paragraphs": [ "For a transient focal event without established mimic, complete urgent vascular assessment and etiologic evaluation rather than discharging on symptom resolution alone. CTA or MRA should be used to confirm stenosis greater than 50% after duplex screening, and laboratory evaluation should include vascular risk testing such as lipid panel, fasting glucose, and HbA1c.[21]", "For an established mimic, document the objective basis for diagnosis and arrange follow-up according to the cause: recurrent seizure-like events require neurology-directed evaluation, recurrent migrainous focal episodes warrant characterization of the stereotyped pattern, and functional presentations require a positive examination-based diagnosis rather than a diagnosis made only after exclusion. The initial workup should be revisited if recurrence deviates from the prior established pattern.[3][9]" ], "bullets": [ "A final diagnosis of stroke mimic does not erase vascular risk: reconsider TIA or ischemic stroke after a transient deficit when vascular imaging, MRI, or symptom pattern remains concerning.[17][21]" ], "subsections": [], "table": { "caption": "", "columns": [], "rows": [] } } ], "faq": [], "references": [ { "number": 1, "title": "Moving From CT to MRI Paradigm in Acute Ischemic Stroke", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/STROKEAHA.123.045154", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 2, "title": "Guidelines for the Early Management of Patients With ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/str.0b013e318284056a", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 3, "title": "Guidelines for the Early Management of Adults With ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.107.181486", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 4, "title": "2026 Guideline for the Early Management of Patients With ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/pdf/10.1161/STR.0000000000000513?download=true", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 5, "title": "Pediatric Arterial Ischemic Stroke - 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A case-based review - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9437493", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 20, "title": "Stroke-like Episodes in Inherited Neurometabolic Disorders - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9611026", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 21, "title": "Transient Ischemic Attack - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK459143", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 22, "title": "Stroke and transient ischaemic attack in over 16s: ...", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/ng128/chapter/recommendations", "authors": "www.nice.org.uk", "host": "www.nice.org.uk" }, { "number": 23, "title": "Study Details | NCT03192332 | Bridging Thrombolysis Versus Direct Mechanical Thrombectomy in Acute Ischemic Stroke | ClinicalTrials.gov", "detail": "clinicaltrials.gov", "url": "https://clinicaltrials.gov/study/NCT03192332", "authors": "clinicaltrials.gov", "host": "clinicaltrials.gov" }, { "number": 24, "title": "Effects of increasing IV tPA-treated stroke mimic rates at CT-based centers on clinical outcomes", "detail": "www.neurology.org", "url": "https://www.neurology.org/doi/10.1212/WNL.0000000000004149", "authors": "www.neurology.org", "host": "www.neurology.org" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Moving From CT to MRI Paradigm in Acute Ischemic Stroke", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/STROKEAHA.123.045154", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "by CM Rapillo · 2024 · Cited by 61 — Compared with the CT-first paradigm, the MRI-first paradigm was associated with lower rates of stroke mimics treated with IVT and fewer repeated", "score": 0.3013317 }, { "number": 2, "title": "Guidelines for the Early Management of Patients With ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/str.0b013e318284056a", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "by EC Jauch · 2013 · Cited by 6292 — If severe enough, hypoglycemia is known to cause autonomic and neurological symptoms, including stroke mimics and seizures.", "score": 0.5303587 }, { "number": 3, "title": "Guidelines for the Early Management of Adults With ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.107.181486", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Several tests should be performed routinely in patients with suspected ischemic stroke to identify systemic conditions that may mimic or cause stroke or that may influence therapeutic options (Table 9). These tests include blood glucose, electrolytes, complete blood count with platelet count, prothr", "score": 0.48630774 }, { "number": 4, "title": "2026 Guideline for the Early Management of Patients With ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/pdf/10.1161/STR.0000000000000513?download=true", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "The very small risk of treatment of a stroke mimic is likely outweighed by the major potential benefit of IVT.", "score": 0.4003513 }, { "number": 5, "title": "Pediatric Arterial Ischemic Stroke - Continuum", "detail": "journals.lww.com", "url": "https://journals.lww.com/continuum/fulltext/2014/04000/pediatric_arterial_ischemic_stroke.14.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Based on the patient's age, awareness of stroke mimics such as focal seizures, hemiplegic migraine, demyelination, tumor with hemorrhage, hypoglycemia, and", "score": 0.5172057 }, { "number": 6, "title": "Study Suggests tPA is 'Safe' for Ischemic Stroke False Alarms", "detail": "journals.lww.com", "url": "https://journals.lww.com/neurotodayonline/fulltext/2010/05200/study_suggests_tpa_is__safe__for_ischemic_stroke.15.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "The most common symptoms in stroke mimic patients were seizure, complicated migraine, and conversion disorder, and there were single cases of", "score": 0.41805586 }, { "number": 7, "title": "DIAGNOSIS OF STROKE AND STROKE MIMICS IN THE EMERGENCY SETTING", "detail": "journals.lww.com", "url": "https://journals.lww.com/continuum/fulltext/2008/12000/DIAGNOSIS_OF_STROKE_AND_STROKE_MIMICS_IN_THE.3.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": ". Neurology 1999;53(1):126-131.\n\nGoogle Scholar\n\nAdams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Interve", "score": 0.41406992 }, { "number": 8, "title": "Stroke Is Best Managed by a Neurologist: Battle of the Titans", "detail": "journals.lww.com", "url": "https://journals.lww.com/TDOJ/00007670-200311000-00059.fulltext", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "by KR Lees · 2003 · Cited by 24 — neurologists are judged able to diagnose nonneurological stroke mimics such as syncope, hypoglycemia, hyponatremia, acute confusion due to drugs, or sepsis,", "score": 0.4017588 }, { "number": 9, "title": "Ischemic stroke mimics: A comprehensive review", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0967586821004811", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "(p<0.001). Excellent outcome was (mRS 0–1) was reported in 41.8% ischemic stroke patients vs. 68.9% SMs (p<0.001). Apart from HINTS manouvre or Hoover sign there is no specific method in the identification of mimics. MRI DWI or perfusion imaging have a role in the setup of differential diagnosis, bu", "score": 0.34740478 }, { "number": 10, "title": "High mimic rate among recipients of intravenous thrombolysis for acute minor ischemic stroke presenting with disabling symptoms", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S1052305725000771", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "was higher among stroke patients compared to stroke mimics (9 % vs 0 %, p = 0.30). One patient developed symptomatic intracerebral hemorrhage, two patients experienced asymptomatic intracerebral hemorrhage and one patient had gross hematuria while no adverse events were observed in the stroke mimic ", "score": 0.7178241 }, { "number": 11, "title": "Randomised, controlled Trial of CT perfusion and ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/esj/article/11/1/23969873251372348/8407736", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by KW Muir · 2026 · Cited by 2 — Safety of thrombolysis in stroke mimics: results from a multicenter cohort study ... Predictors of acute stroke mimics in 8187 patients", "score": 0.71040785 }, { "number": 12, "title": "Stroke Mimics and Acute Stroke Evaluation: Clinical ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0736467914014607", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "by PL Nguyen · 2015 · Cited by 69 — Safety and outcomes of intravenous thrombolysis in stroke mimics: a 6-year, single-care center study and a pooled analysis of reported series Stroke", "score": 0.64128816 }, { "number": 13, "title": "Tumefactive demyelinating disorders as stroke mimics", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S2211034823002948", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "by M Vaišvilas · 2023 · Cited by 6 — Tsivgoulis, et al. Safety and outcomes of intravenous thrombolysis in stroke mimics: a 6-year, single-care center study and a pooled analysis of reported series.", "score": 0.6102915 }, { "number": 14, "title": "A novel stroke mimic prediction score during in-hospital triage ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/esj/article/10/4/1462/8377190", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by I Scala · 2025 · Cited by 1 — The primary aim of this study was to identify diagnostic predictors of stroke mimics based on parameters acquired during the ED triage of patients with", "score": 0.43136916 }, { "number": 15, "title": "Stroke and Stroke Mimics: Diagnosis and Treatment - NCBI", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK554340", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "## 3.9. Stroke Mimics\n\nStroke mimics or non-ischemic etiologies represent up to one-third of cases of new neurological deficits . It is important to identify these mimics correctly to avoid unnecessary acute treatment. MRI has a distinct advantage in identifying stroke mimics and narrows the differe", "score": 0.5942929 }, { "number": 16, "title": "Stroke and Its Mimics: Diagnosis and Treatment - Diseases of the Brain, Head and Neck, Spine 2024-2027 - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK608608", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "## 3.8. Stroke Mimics\n\nAlmost one-third cases of new focal neurological deficits can be stroke mimics . It is important to identify stroke mimics and differentiate from true strokes to avoid inappropriate treatment. MRI has inherent advantages over CT to identify mimics. The more common stroke mimic", "score": 0.48147875 }, { "number": 17, "title": "Stroke mimics: incidence, aetiology, clinical features and treatment", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7939567", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "evident on CTP may be helpful, especially when the distal intracranial occlusion may not be visible on the CTA. The presence of normal CT, CTA and CTP should alert the physician to the possibility of a stroke mimic. CTP may however frequently show non-specific findings in mimics. These are however d", "score": 0.47899243 }, { "number": 18, "title": "Integrative Approaches in Acute Ischemic Stroke - PMC - NIH", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10604797", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Transitioning from MRI to the realm of computed tomography (CT), the trio of CT, CT angiography (CTA), and CT perfusion (CTP) reign supreme in emergency departments when there is a hint of cerebrovascular compromise . The pressure-cooker environment of emergency settings demands precise and rapid im", "score": 0.40867847 }, { "number": 19, "title": "Arterial Spin Labeling technique and clinical applications of the intracranial compartment in stroke and stroke mimics - A case-based review - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9437493", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Extreme electrophysiological state with increased glucose and oxygen\ndemand during ictal phase causes compensatory regional hyperperfusion.\nThis ictal hyperperfusion is identified as increased ASL signals in the\nepileptogenic focus (Figure 9).65-67 When this\nhyperperfusion is no longer sufficient to", "score": 0.3502663 }, { "number": 20, "title": "Stroke-like Episodes in Inherited Neurometabolic Disorders - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9611026", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "During the whole diagnostic process in patients with focal neurological symptoms, it is essential to take into consideration the possibility of SLE, especially in the pediatric population. The overall prevalence of inborn errors of metabolism is quite high, even if the frequency of individual disord", "score": 0.334503 }, { "number": 21, "title": "Transient Ischemic Attack - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK459143", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Transient ischemic attack (TIA) represents an acute, transient episode of focal neurologic dysfunction resulting from cerebral, spinal, or retinal ischemia without acute infarction, now defined by tissue-based criteria rather than symptom duration. This course reviews the urgent evaluation, rapid ne", "score": 0.24720559 }, { "number": 22, "title": "Stroke and transient ischaemic attack in over 16s: ...", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/ng128/chapter/recommendations", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "##### 1.4.3\n\nStaff in emergency departments, if appropriately trained and supported, can administer alteplase or tenecteplase for the treatment of ischaemic stroke provided that patients can be managed within an acute stroke service with appropriate neuroradiological and stroke physician support. [2", "score": 0.38789952 }, { "number": 23, "title": "Study Details | NCT03192332 | Bridging Thrombolysis Versus Direct Mechanical Thrombectomy in Acute Ischemic Stroke | ClinicalTrials.gov", "detail": "clinicaltrials.gov", "url": "https://clinicaltrials.gov/study/NCT03192332", "authors": "clinicaltrials.gov", "host": "clinicaltrials.gov", "snippet": "10. Known advanced dementia or significant pre-stroke disability (mRS score of ≥2)\n11. Foreseeable difficulties in follow-up due to geographic reasons (e.g. patients living abroad)\n12. Comorbid disease or condition that would confound the neurological and functional evaluations or compromise s", "score": 0.200793 }, { "number": 24, "title": "Effects of increasing IV tPA-treated stroke mimic rates at CT-based centers on clinical outcomes", "detail": "www.neurology.org", "url": "https://www.neurology.org/doi/10.1212/WNL.0000000000004149", "authors": "www.neurology.org", "host": "www.neurology.org", "snippet": "Crossref08020-9)\n\nPubMed\n\nGoogle Scholar\n\n18.\n\nBrown MD, Burton JH, Nazarian DJ, Promes SB. Clinical policy: use of intravenous tissue plasminogen activator for the management of acute ischemic stroke in the emergency department. _Ann Emerg Med_ 2015;66:322–333.e331.\n\nCrossref\n\nPubMed\n\nGoogle Schola", "score": 0.7368747 } ], "publishedAt": "2026-08-21T02:38:46.544176+00:00", "updatedAt": "2026-08-21T02:38:46.544176+00:00", "readingMinutes": 6, "slug": "stroke-mimics" }