Stroke Differential Diagnosis and Mimics: Part 1

Shahmir Kamalian, MD; Shervin Kamalian, MD; Daniel J. Boulter, MD; Michael H. Lev, MD; R. Gilberto Gonzalez, MD, PhD; Pamela W. Schaefer, MD


Appl Radiol. 2015;44(11):26-39. 

In This Article

Abstract and Introduction


An estimated 9% to 30% of patients with suspected stroke and 2.8% to 17% of patients treated with IV-tPA have stroke mimics.[1–7] The majority of stroke mimics are due to seizures, migraines, tumors and toxic-metabolic disturbances.[3,8] Imaging usually facilitates diagnosis, as stroke has typical imaging features at different stages and follows typical topographic patterns. However, most of these features, even restricted diffusion (Table 1), are not unique to stroke.[9–17] In this article we present stroke and its mimics based on 7 main patterns of topographic distribution (Figure 1). Although overlap exists, these patterns are helpful in narrowing the differential diagnosis.

Figure 1.

Six main patterns of imaging findings in stroke and its mimics. (*) denotes ischemic causes.