Stroke Mimics
This table describes the clinical differences between strokes and stroke mimics.
|
Mimic |
Clinical differences between a stroke and the mimic |
| Migraine |
Often associated with an aura: a ‘positive’ symptom. A stroke involves loss of neurological function i.e. ‘negative symptoms’ Note: Headache is not a feature of ischaemic stroke but is often associated with intracerebral haemorrhage. |
| Hypoglycaemia | A bedside glucose test will identify this clinical situation. All thrombolysis protocols require exclusion of hypoglycaemia |
| Seizure | Seizures may be a complication of an acute stroke or may develop in someone with a history of stroke. However, presentation with a seizure is shown to reduce the odds ratio of the patient having a stroke (OR 0.28) |
| Brain tumour, space-occupying lesion or sub dural | Usually more gradual onset, though features may be the same. This will be rapidly distinguished on brain imaging |
| Sepsis | The patient usually has systemic symptoms of sepsis such as fever. Severe sepsis associated with systemic hypoperfusion may cause watershed area neurological dysfunction |
| Syncope | Stroke rarely presents with syncope alone |
| Toxic metabolic states | Hyperglycaemia and hyponatraemia can present with focal neurology. Confusion and slurred speech may be present |
| CN VII nerve palsy | A peripheral VIIth cranial nerve palsy is a lower motor neuron lesion, and so the whole of one side of the face is weak. In an upper motor neuron lesion from a stroke (MCA territory), only the lower two-thirds of the face is weak |