“Under the age of 50, most stroke mimics are migraines, epilepsy, seizures, multiple sclerosis or high blood pressure that causes swelling in the brain,” he said. “Over the age of 50, most patients experiencing a stroke mimic are the result of epilepsy, metabolic derangement or a mass lesion in the brain.”
In daily practice, MRI is often used to increase diagnostic certainty and even to guide decision making in providing therapy5 However, in up to one third of patients with a diagnosis of ischemic stroke no corresponding lesion is found on MRI performed within 2 weeks of onset of complaints (i.e. MRI negative stroke).
Some of the most common stroke mimics are seizures, migraine, fainting, serious infections and functional neurological disorder (FND). Once the person is diagnosed, they can have treatment or support to manage their symptoms.
An MRI scan shows brain tissue in greater detail, allowing smaller, or more unusually located, areas affected by a stroke to be identified. As with a CT scan, special dye can be used to improve MRI scan images.
Intracranial tumors may present with sudden onset of stroke-like symptoms, also called “tumor attacks” (8, 21-23), which sometimes are misdiagnosed as ischemic stroke.
Gliomas, meningiomas and hypophyseal adenomas are among the commonest primary tumors that may mimic a stroke. Metastatic lesions of the brain may have a similar presentation. Primary tumours which most frequently metastasize in the brain include lungs, breast, alimentary canal, kidneys and skin melanomas1.
A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke. A TIA usually lasts only a few minutes and doesn't cause permanent damage. Often called a ministroke, a TIA may be a warning.
An MRI can sometimes show the site of the TIA, especially if it's done soon after it happens. But this is not the main way that a TIA is diagnosed.
Usually, a silent stroke is discovered unexpectedly on a brain CT or brain MRI. These imaging tests can easily distinguish past strokes from recent strokes.
Hypoglycemia occurs when a person's blood sugar is very low, and it can mimic the symptoms of a stroke. A doctor should be able to rule it out fairly quickly with a blood glucose test, but it also can be misdiagnosed instead of a stroke.
Yes, it's possible. In fact, a statement issued by the American Stroke Association and American Heart Association estimated that as many as a quarter of octogenarians may have experienced one or more strokes without symptoms. These events are often detected only when a person undergoes brain imaging for another reason.
Stroke misdiagnosis can mean the failure to recognize a stroke immediately after or while it is occurring, or overlooking signs of an impending stroke. The best way to avoid permanent disability or death is to avoid it altogether.
MAGNETIC RESONANCE DIFFUSION
MRI with diffusion is quickly becoming the gold standard in acute stroke imaging. Once a hemorrhagic stroke has been excluded by CT, MR diffusion improves stroke detection from 50% to more than 95%. Diffusion MR noninvasively detects ischemic changes within minutes of stroke onset.
Like a CT scan, a stroke MRI takes multiple images of the inside of the head using sophisticated x-rays and computers. Unlike a CT scan, which takes several hours to reveal any blockages of blood flow, an MRI can uncover any brain damage within an hour of the onset of the stroke symptoms.
Brain scans
Computerised tomography (CT scan) and magnetic resonance imaging (MRI) take pictures of your brain that show areas of damage and swelling. Either a CT scan or MRI should be done urgently within the first 24 hours after a stroke. This is to work out the type of stroke (ischaemic or haemorrhagic).
Warning signs of an ischemic stroke may be evident as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients published in the March 8, 2005 issue of Neurology, the scientific journal of the American Academy of Neurology.
Tests will be done to rule out a stroke or other disorders that may cause the symptoms: You will likely have a head CT scan or brain MRI. A stroke may show changes on these tests, but TIAs will not. You may have an angiogram, CT angiogram, or MR angiogram to see which blood vessel is blocked or bleeding.
Symptoms to Watch For
You likely won't know for certain that you have suffered a silent stroke without receiving a brain scan like an MRI or CT scan. After a silent stroke, a brain scan can show small white spots that indicate the presence of lesions.
These brief episodes are transient ischemic attacks (TIA), sometimes called “mini-strokes.” They still should be taken seriously, because they tend to be signs of underlying serious conditions that can lead to a full stroke, even possibly in the few days following a TIA event if not evaluated and treated for a TIA.
Some people will experience symptoms such as headache, numbness or tingling several days before they have a serious stroke. One study found that 43% of stroke patients experienced mini-stroke symptoms up to a week before they had a major stroke.
Call 9-1-1 immediately if any of these signs of stroke appear: Numbness or weakness in the face, arm, or leg; Confusion or trouble speaking or understanding speech; Trouble seeing in one or both eyes; Trouble walking, dizziness, or problems with balance; severe headache with no known cause.
A person's life expectancy after a mini stroke reduces by around 4% in the first year following the attack in comparison to people who have not had one. In the following 9 years, life expectancy reduces by 20%. These statistics come from a 2019 review .
Common symptoms of brain tumours include headaches, feeling or being sick and seizures (fits). These symptoms and the others listed below are often caused by other medical conditions. But if you have any of them, it's important to see your doctor.