Secondary Logo

Institutional members access full text with Ovid®

The frequency, characteristics and aetiology of stroke mimic presentations

a narrative review

McClelland, Grahama,c; Rodgers, Helena; Flynn, Darrenb; Price, Christopher I.a

European Journal of Emergency Medicine: February 2019 - Volume 26 - Issue 1 - p 2–8
doi: 10.1097/MEJ.0000000000000550

A significant proportion of patients with acute stroke symptoms have an alternative ‘mimic’ diagnosis. A narrative review was carried out to explore the frequency, characteristics and aetiology of stroke mimics. Prehospital and thrombolysis-treated patients were described separately. Overall, 9972 studies were identified from the initial search and 79 studies were included with a median stroke mimic rate of 19% (range: 1–64%). The prehospital median was 27% (range: 4–43%) and the thrombolysis median 10% (range: 1–25%). Seizures, migraines and psychiatric disorders are the most frequently reported causes of stroke mimics. Several characteristics are consistently associated with stroke mimics; however, they do not fully exclude the possibility of stroke. Nineteen per cent of suspected stroke patients had a mimic condition. Stroke mimics were more common with younger age and female sex. The range of mimic diagnoses, a lack of clear differentiating characteristics and the short treatment window for ischaemic stroke create challenges for early identification.

aStroke Research Group, Institute of Neuroscience

bInstitute of Health and Society, Newcastle University

cNorth East Ambulance Service NHS Foundation Trust, Newcastle, UK

Correspondence to Graham McClelland, MClinRes, Stroke Research Group, Institute of Neuroscience, Newcastle University, 3-4 Claremont Terrace, Newcastle Upon Tyne NE2 4AE, UK Tel: +44 191 208 6232; e-mail:

Received October 7, 2017

Accepted February 18, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.