Differential Diagnosis for Leading Stroke Mimics
Single Most Likely Diagnosis
- Seizure: A seizure can present with sudden onset of focal neurological deficits, mimicking a stroke. The post-ictal phase, characterized by confusion and lethargy, can further confuse the diagnosis.
- Migraine: Migraines, especially those with aura, can cause transient neurological symptoms that may be mistaken for a stroke, including visual disturbances, sensory changes, and speech difficulties.
Other Likely Diagnoses
- Syncope: A syncopal episode, especially if prolonged, can lead to transient neurological deficits due to decreased cerebral perfusion, which might be mistaken for a stroke.
- Hypoglycemia: Low blood sugar can cause a range of neurological symptoms, including confusion, weakness, and even focal neurological deficits, making it a common mimic of stroke.
- Vestibular disorders: Conditions like benign paroxysmal positional vertigo (BPPV) or labyrinthitis can cause sudden onset of vertigo, which might be confused with the vertigo associated with a posterior circulation stroke.
Do Not Miss Diagnoses
- Subarachnoid hemorrhage: Although it's a type of stroke, its presentation can sometimes be atypical, and missing it can be catastrophic. It often presents with a sudden, severe headache.
- Meningitis or encephalitis: Infections of the meninges or brain can cause a range of neurological symptoms, including fever, confusion, and focal neurological signs, which could be mistaken for a stroke.
- Hyperglycemic hyperosmolar nonketotic syndrome (HHNS): This condition, associated with very high blood glucose levels, can cause seizures, focal neurological deficits, and altered mental status, mimicking stroke.
Rare Diagnoses
- Multiple sclerosis: An acute relapse of multiple sclerosis can present with a wide range of neurological symptoms, including optic neuritis, transverse myelitis, or brainstem syndromes, which might be confused with a stroke.
- Mitochondrial myopathies: Certain mitochondrial disorders can cause stroke-like episodes, characterized by focal neurological deficits, often with a headache and seizures.
- Hashimoto's encephalopathy: A rare condition associated with autoimmune thyroiditis, characterized by encephalopathy, seizures, and sometimes stroke-like symptoms, which can be very misleading.