Stroke or Stroke Mimic? 7 Health Conditions With Symptoms Similar to Stroke

When stroke symptoms hit — sudden numbness, confusion, slurred speech — time is critical. But what if those alarming signs aren't caused by a stroke at all? In many cases, patients rushed to stroke centres are later diagnosed with something else entirely: a stroke mimic. These are medical conditions that closely resemble a stroke, triggering similar physical or cognitive symptoms.

Recognising the difference between a stroke and a stroke mimic can be life-saving — and it can also prevent unnecessary treatments like clot-busting drugs. Here, we shine a light on 7 common stroke mimics and their typical symptoms, so you can take fast, informed action.

Key Takeaways

• Stroke mimics are conditions that imitate stroke symptoms.

• Seizures, migraines and low blood sugar are frequent culprits.

• Some mimics are neurological disorders, such as Bell’s palsy or multiple sclerosis.

• Functional neurological disorder is often mistaken for a stroke.

• Immediate medical assessment is crucial — even if it’s “just” a mimic.
  
  

Why Stroke Mimics Matter

A stroke remains one of the most critical medical emergencies and a leading cause of death and long-term disability globally (American Heart Association, 2023). When a stroke strikes, every second counts — the faster a person receives medical care, the greater the chances of preserving brain function and reducing permanent damage.

But here’s the dilemma: not every patient who appears to be having a stroke is actually experiencing one. Up to 30% of stroke presentations turn out to be stroke mimics — conditions that produce symptoms so similar to a stroke that they can fool even experienced emergency responders and clinicians (International Stroke Conference, 2024).

This raises a critical challenge in acute care: how can professionals distinguish a true stroke from a functional or metabolic mimic without delaying lifesaving treatment?

The answer is simple: treat every sign and symptom of a stroke as a medical emergency. Even if it turns out to be a mimic, the risk of overlooking a true stroke is too great to delay action. Time lost is brain lost — and early intervention remains the cornerstone of positive stroke outcomes.

The Importance of Recognising Stroke-Like Symptoms

Classic stroke signs like facial drooping, slurred speech, arm weakness, and sudden confusion are heavily emphasised in public health messaging. However, these same symptoms may appear in patients experiencing non-stroke events, such as seizures, migraine auras, or hypoglycaemic episodes (Stroke Association, 2024).

This overlap creates significant diagnostic pressure. Treating a stroke mimic as a real stroke could subject patients to unnecessary procedures like thrombolysis, which carries its own risks. Conversely, mistaking a true stroke for a mimic can delay urgent treatment and lead to permanent disability or death (American Stroke Association, 2023).

Identifying the subtle differences in symptom evolution, patient history, and accompanying signs is crucial. Emergency teams typically rely on head CT scans, blood glucose tests, and rapid neurological evaluations to differentiate — although even these tools may not always be definitive (Stroke Association, 2024).

Stroke Mimics and Their Typical Symptoms

• Stroke mimics generally fall into three categories:

• Neurological disorders (e.g. seizures, Bell’s palsy, multiple sclerosis)

• Metabolic imbalances (e.g. hypoglycaemia)

• Functional neurological conditions (e.g. conversion disorder, functional stroke)
  

All of these may produce hallmark stroke-like symptoms, such as one-sided weakness, speech difficulties, vision loss, or altered consciousness. What they often lack, however, are the vascular changes or imaging evidence typical of actual strokes (International Stroke Conference, 2024).

For example, patients with functional neurological disorder (FND) may present with paralysis or aphasia, yet show no abnormalities on CT or MRI. Likewise, a migraine aura can closely resemble a posterior circulation stroke, with symptoms that are often transient and reversible (American Stroke Association, 2023).

Understanding the nature of these mimics and their typical symptoms is critical — not just for emergency doctors, but also for patients and carers. It helps avoid misdiagnosis, reduce unnecessary stroke admissions, and tailor the right diagnosis and treatment plan for each case.

7 Common Stroke Mimics Explained

1. Seizures

Seizures, particularly focal seizures or those followed by a postictal state, can result in temporary confusion, disorientation, weakness, or even unilateral paralysis. This condition, known as Todd’s paralysis, can last minutes to hours and mimics the physical deficits seen in acute stroke (American Stroke Association, 2023). Patients may also experience slurred speech, altered consciousness, or visual disturbances, all of which can closely resemble a cortical stroke. The differentiation often relies on neuroimaging and patient history, especially if there is a history of epilepsy.

2. Migraines

Hemiplegic migraines, a rare type of migraine with aura, can cause temporary one-sided weakness, visual changes, numbness, and difficulty speaking — all classic stroke symptoms (Stroke Association, 2024). These episodes are particularly common in younger individuals and can last hours. Because they often mimic posterior circulation stroke syndromes, they are a frequent cause of misdiagnosis in emergency settings. Neurological exams and imaging typically show no evidence of stroke, and a history of migraines is usually a key clue.

3. Low Blood Sugar (Hypoglycaemia)

Hypoglycaemia occurs when blood glucose levels drop below the normal range, leading to a variety of neurological symptoms. These can include confusion, dizziness, blurred vision, slurred speech, loss of coordination, and even seizures — all of which may mimic stroke presentation (Stroke Association, 2024). Quick blood glucose testing is an essential first-line assessment in all patients with suspected stroke, especially those with diabetes or altered consciousness (International Stroke Conference, 2024).

4. Brain Tumours

Slow-growing or sudden-onset brain tumours can disrupt brain function, particularly in areas related to speech, movement, and cognition. Symptoms may develop gradually and include personality changes, speech difficulties, unilateral weakness, and vision problems, which can be mistaken for a stroke, particularly if they present acutely (American Stroke Association, 2023). MRI is typically used to differentiate tumours from stroke, especially if CT imaging appears normal.

5. Functional Neurological Disorder (FND)

Functional Neurological Disorder (FND) is a condition where patients experience real neurological symptoms — such as paralysis, gait disturbances, numbness, or non-epileptic seizures — without any detectable structural or physiological abnormalities in the brain. These symptoms often mimic stroke but are psychogenic in origin (International Stroke Conference, 2024). Patients with FND are frequently misdiagnosed and may receive stroke treatment unnecessarily unless a thorough neurological and psychological evaluation is conducted.

6. Bell’s Palsy

Bell’s palsy is a sudden, unilateral facial paralysis caused by inflammation of the facial nerve (cranial nerve VII). Because it can occur abruptly and mimic the facial droop seen in stroke, it is a common stroke mimic (Stroke Association, 2024). The key difference is that Bell’s palsy does not affect speech, limb strength, or consciousness, and the entire side of the face is usually involved — unlike stroke, which often spares the forehead.

7. Multiple Sclerosis (MS)

Multiple sclerosis (MS) is an autoimmune condition affecting the central nervous system. Acute relapses may present with vision loss, one-sided weakness, numbness, or speech issues, all of which can resemble an acute ischaemic stroke (American Heart Association, 2023). Diagnosis typically requires MRI, and symptoms may resolve more slowly than stroke. MS should be considered in younger patients with unusual or recurring neurological episodes.

FAQs About Stroke Mimics

What is the difference between a stroke and a stroke mimic?

A stroke is caused by a blockage or bleed in the brain's blood vessels, while a stroke mimic is a different condition that presents with similar symptoms but lacks the vascular damage seen in a stroke.

Can stroke mimics be life-threatening?

Yes. While not all stroke mimics are fatal, some (like seizures or hypoglycaemia) can become dangerous if not treated promptly.

How do doctors tell if it's a stroke or a mimic?

Clinicians use brain imaging (like a CT scan), blood tests, and neurological assessments to distinguish between strokes and mimics. Patient history and symptom evolution are also key.

Is treatment different for stroke mimics?

Yes. Since the underlying causes are different, stroke mimics require their own diagnosis and treatment plans tailored to the specific condition.

Should I still call emergency services if symptoms might be a mimic?

Absolutely. Any stroke-like symptoms should be treated as a medical emergency until proven otherwise. Quick action is crucial.

Conclusion

When it comes to stroke, there’s a simple rule: treat every symptom like it’s the real thing. Whether it turns out to be a true acute stroke or a stroke mimic, time is a critical factor. The brain is highly sensitive to reduced blood flow, and every minute without proper intervention leads to further neuronal loss — roughly 1.9 million neurons per minute, according to the American Stroke Association (2023). That means delaying treatment — even by a few minutes — can result in long-term disability or death.

What makes this even more complex is that stroke mimics can look identical to real strokes, especially in the early moments. Conditions like seizures, migraines, hypoglycaemia, or functional neurological disorder can all present with stroke-like symptoms: slurred speech, limb weakness, facial droop, or confusion. Yet despite being non-stroke in origin, these mimics still require urgent diagnosis and treatment, as they can also lead to severe complications if ignored.

From the perspective of a bystander, the response should always be the same: act fast. Use the FAST test — Face drooping, Arm weakness, Speech difficulty, Time to call — and seek emergency help. Do not attempt to self-diagnose. Even trained clinicians may struggle to differentiate a stroke from a mimic without a head CT scan, blood work, and a full neurological assessment.

If you or someone near you is showing symptoms similar to a stroke, call emergency medical services immediately. Time saved is brain saved, and whether it's a stroke or something else, quick action is your best defence against serious, lasting harm.

References

American Heart Association. (2023). Stroke Symptoms and Warning Signs. https://www.stroke.org/en/about-stroke/stroke-symptoms

American Stroke Association. (2023). Understanding stroke mimics. https://www.stroke.org/en/about-stroke/stroke-symptoms/stroke-mimics

American Stroke Association News (2024)
When Symptoms Suggest a Stroke, But It’s Something Else https://www.heart.org/en/news/2024/02/02/when-symptoms-suggest-a-stroke-but-its-something-else

American Stroke Association / American Heart Association (2025)
Stroke Symptoms and Warning Signs https://www.stroke.org/en/about-stroke/stroke-symptoms

Andersson, J., Asa Rejnö, Sofie Jakobsson, Hansson, P.-O., Nielsen, S. J., & Björck, L. (2024). Symptoms at stroke onset as described by patients: a qualitative study. BMC Neurology, 24(1). https://doi.org/10.1186/12883-024-03658-4

International Stroke Conference. (2024). Stroke mimics and early differential diagnosis: Emergency protocols in practice. https://professional.heart.org/en/meetings/international-stroke-conference

Loukas, M. (2014). The neurologist's dilemma: A comprehensive clinical review of Bell's palsy, with emphasis on current management trends. Medical Science Monitor, 20, 83-90. https://doi.org/10.12659/msm.889876

Pohl, M., Hesszenberger, D., Kapus, K., Meszaros, J., Feher, A., Varadi, I., Pusch, G., Fejes, E., Tibold, A., & Feher, G. (2021). Ischemic stroke mimics: A comprehensive review. Journal of Clinical Neuroscience, 93(93), 174–182. https://doi.org/10.1016/j.jocn.2021.09.025

Stroke Association. (2024). Stroke and conditions that mimic stroke symptoms. https://www.stroke.org.uk/what-is-stroke/stroke-symptoms/stroke-mimics