Stroke mimics: incidence, aetiology, clinical features and treatment

Ann Med. 2021 Dec;53(1):420-436. doi: 10.1080/07853890.2021.1890205.


Mimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.

Keywords: MRI; Stroke; TIA; mimics; recurrence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain Ischemia / diagnostic imaging*
  • Humans
  • Incidence
  • Magnetic Resonance Imaging / methods*
  • Stroke / diagnosis
  • Stroke / epidemiology*
  • Stroke / etiology*
  • Stroke / therapy
  • Tomography, X-Ray Computed / methods*

Grants and funding

Open Access funding provided by the Qatar National Library. Anas Alrohimi thanks King Saud University and the Saudi Arabian Ministry of Education for Residency and Fellowship funding.