Table 3 Diagnostic approach to distinguish between stroke and stroke mimics

Onset and Course of Symptoms

Sudden onset, reaching peak symptoms early

Gradual, sporadic onset and worsening (e.g., migraine with aura, conversion disorder)

Associated Symptoms

Neurological deficits without specific associated symptoms.

Presence of headache (migraine), palpitations, sweating (hypoglycemia), post-seizure activity

Symptom Pattern

Follows a vascular distribution (specific areas of weakness/deficit)

Generalized weakness not aligned with any specific vascular distribution (e.g., FNDs)

Neuroimaging Results

MRI shows diffusion limitation in ischemic stroke

CT/MRI are often normal, or may show etiological abnormality and not signs of a stroke

Response to Treatment

Requires close medical monitoring, sometimes surgery

Rapid improvement with glucose (hypoglycemia) or psychological interventions (FNDs)