Ischemic stroke mimics (imitators)

Reducing the «door-to-needle» time for revascularization procedures is crucial in providing effective care to patients with acute stroke. Since the «time-to-brain» concept requires rapid diagnostics, multimodal brain imaging is rarely used, and emergency computed tomography (CT) can only exclude the presence of hemorrhage. As a result, according to various meta-analyses, the incidence of stroke imitation in acute vascular departments can reach 25%. At the same time, the incidence of thrombolytic therapy in patients with a «stroke mimics» can reach 17%. Peripheral vestibular dysfunction, toxic/metabolic encephalopathy, seizures, functional disorder, transient global amnesia, migraine, neuropathies, space-occupying lesions, acute confusion are usually hidden under the «mimics of stroke». Clinical neurological examination plays a decisive role in the differential diagnosis of acute stroke and other «disease mimics». The absence or small number of vascular risk factors, younger age, and careful analysis of subtle clinical signs should alert the physician to a possible ischemic stroke-chameleon.