When Stroke Symptoms Signal Something Else

A stroke is a medical emergency—every minute counts. But what happens when stroke-like symptoms turn out to be something else? What else could the symptoms mean? Stroke mimics are conditions that may cause sudden weakness, difficulty speaking, vision changes or dizziness, yet do not result from a blockage or bleeding in the brain. For those who experience them, the uncertainty and stress can be overwhelming.

Why Do Stroke Mimics Happen?

Stroke mimics account for about 1 in 4 stroke-related hospital visits, according to a 2021 review in the Journal of Clinical Neuroscience. While strokes result from blocked or ruptured blood vessels in the brain, mimics may arise from other medical conditions affecting the nervous system. They can be triggered by a wide range of factors, including metabolic imbalances, neurological disorders and even psychological stress.

Conditions that may cause stroke mimics include:

• Seizures – may cause temporary weakness, confusion and slurred speech.
• Migraines – may present with aura, visual disturbances and numbness.
• Psychiatric disorders – functional neurological disorders may cause sudden weakness or speech problems.
• Brain tumors – may lead to neurological symptoms that resemble a stroke.
• Demyelinating diseases (e.g., multiple sclerosis) – may cause weakness, numbness, and coordination problems.
• Metabolic conditions (e.g., low blood sugar) – may lead to confusion, dizziness, or slurred speech.

Stroke vs Stroke Mimic

While stroke may be more common in older adults, stroke mimics may occur across all age groups. A brain scan is one of the first steps in distinguishing a stroke from a stroke mimic.

• Stroke: Imaging may show a blocked artery (ischemic stroke) or bleeding in the brain (hemorrhagic stroke).
• Stroke Mimic: In many cases, no immediate brain damage is visible. However, certain mimics like brain tumors, subdural hematomas, or multiple sclerosis lesions may appear in imaging.

If no abnormalities are found on the initial scan, doctors will continue testing to rule out stroke mimics.

Stroke Risk Factors

• High blood pressure, diabetes, obesity
• Smoking, excessive alcohol use
• Heart disease or irregular heartbeat (atrial fibrillation)
• Age over 50, with risk increasing significantly after 60

Stroke Mimic Risk Factors

• Seizures – more common in individuals with epilepsy or a history of head trauma
• Migraines – more frequent in younger adults and women
• Low or high blood sugar – a concern for people with diabetes
• Functional neurological disorders – may be triggered by psychological stress or trauma

Diagnosis

Don’t diagnose yourself or a loved one; medical attention is needed. Distinguishing between a stroke and a mimic requires a combination of tests and clinical assessments:

• Brain imaging (CT Scan or MRI) – aims to detect bleeding, clots, tumors or other abnormalities.
• Neurological exam – aims to evaluate muscle strength, speech, reflexes and coordination.
• Blood tests – checks for blood sugar imbalances, infections, or metabolic issues.
• Electroencephalogram (EEG) – used if a seizure is suspected.
• Medical history and symptoms timeline

When in Doubt, Call 911

While stroke and stroke mimics may resemble each other, only a thorough medical examination may help pinpoint the real condition. We recommend contacting emergency services for anyone experiencing any of the symptoms.

A stroke is a race against time to get lifesaving treatment quickly. A stroke mimic, while not life-threatening, still requires medical attention to identify the true cause and prevent future episodes.

Act F.A.S.T.

The easiest way to remember the warning signs of a stroke is with the FAST acronym:

• Face drooping – Does one side of the face droop or feel numb?
• Arm weakness – Can the person raise both arms or does one drift downward?
• Speech difficulty – Is speech slurred or hard to understand?
• Time to call 911 – Never wait to see if symptoms improve.