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Related Experiment Video

Updated: Oct 16, 2025

A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
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Ischemic stroke mimics: A comprehensive review.

Marietta Pohl1, David Hesszenberger2, Krisztian Kapus1

  • 1Centre for Occupational Medicine, Medical School, University of Pécs, Pécs, Hungary.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|October 17, 2021
PubMed
Summary
This summary is machine-generated.

Ischemic stroke mimics (SMs) are common and often misdiagnosed, leading to unnecessary thrombolysis. Accurate diagnosis by experienced physicians is crucial for patient safety and better outcomes.

Keywords:
Clinical findingsEtiologyMimicOutcomeStrokeThrombolysis

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Diagnostic Imaging

Background:

  • Ischemic stroke is a leading cause of death and disability worldwide.
  • Ischemic stroke mimics (SMs) are frequently misdiagnosed as acute stroke, sometimes leading to inappropriate thrombolysis.
  • Understanding SMs is critical for accurate diagnosis and treatment in acute stroke settings.

Purpose of the Study:

  • To conduct a comprehensive review of studies on ischemic stroke mimics (SMs).
  • To summarize the prevalence, types, risk factors, symptoms, and outcomes of SMs in patients evaluated for acute stroke.
  • To assess the safety and efficacy of thrombolysis in patients with SMs.

Main Methods:

  • Systematic review of 61 studies involving 62,664 participants.
  • Analysis of data on the prevalence, clinical characteristics, and treatment outcomes of SMs.
  • Comparison of characteristics and outcomes between ischemic stroke patients and SMs.

Main Results:

  • The overall prevalence of SMs was 24.8%.
  • Common SMs include vestibular dysfunction, toxic/metabolic disturbances, seizures, functional disorders, and migraine.
  • SMs patients were younger, had fewer vascular risk factors, and experienced less severe symptoms than ischemic stroke patients.
  • Thrombolysis was administered less frequently to SMs (26.3%) compared to ischemic stroke patients (61.7%).
  • Intracranial hemorrhage and death rates were significantly lower in SMs (0.7% and 1.9%, respectively) compared to stroke patients (9.4% and 11.3%, respectively).
  • Excellent outcomes (mRS 0-1) were more common in SMs (68.9%) than in stroke patients (41.8%).

Conclusions:

  • Ischemic stroke mimics are common and present differently from true ischemic strokes.
  • While thrombolysis appears relatively safe in SMs, accurate diagnosis is paramount.
  • Physician expertise in differentiating SMs from ischemic stroke, particularly for conditions like vertigo, headache, and seizure, is essential for optimal patient care.