Acute stroke differential diagnosis: Stroke mimics

Eur J Radiol. 2017 Nov:96:133-144. doi: 10.1016/j.ejrad.2017.05.008. Epub 2017 May 5.


Stroke mimics (SM) are non-vascular conditions that present with an acute neurological deficit simulating acute ischemic stroke and represent a significant percentage of all acute stroke hospital admissions. The most common clinical SM includes conversion/functional (psychiatric disorder); seizures and postictal paralysis; toxic-metabolic disturbances; brain tumours; infections, and migraine. Imaging is essential for SM recognition, being Diffusion weighted imaging (DWI), perfusion imaging and angiographic studies very useful. There are several disorders that may have imaging features that simulate acute ischemic stroke, mainly presenting with cytotoxic oedema and/or perfusion deficits. The imaging features of the most frequent clinical and imaging stroke mimics are reviewed.

Keywords: Acute ischemic stroke; Migraine; Posterior Reversible Encephalopathy Syndrome PRES; Reversible Cerebral Vasoconstriction Syndrome RCVS; Seizures; Stroke mimic; Transient periictal MRI abnormalities TPMA.

Publication types

  • Review

MeSH terms

  • Brain Edema / diagnostic imaging*
  • Brain Edema / physiopathology
  • Brain Ischemia / diagnostic imaging*
  • Brain Ischemia / physiopathology
  • Brain Neoplasms / diagnostic imaging*
  • Brain Neoplasms / physiopathology
  • Diagnosis, Differential
  • Diffusion Magnetic Resonance Imaging
  • Humans
  • Magnetic Resonance Angiography
  • Migraine Disorders / diagnostic imaging*
  • Migraine Disorders / physiopathology
  • Neuroimaging*
  • Perfusion Imaging / methods
  • Predictive Value of Tests
  • Seizures / diagnostic imaging*
  • Seizures / physiopathology
  • Stroke / diagnosis*