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Abstract
Stroke remains a leading cause of death and long-term disability worldwide, with time-dependent reperfusion therapies offering substantial benefit when administered promptly. However, up to 30% of patients presenting with acute focal neurological deficits are ultimately diagnosed with stroke mimics — conditions that closely imitate stroke but have fundamentally different pathophysiology and management. Conversely, stroke chameleons are true cerebrovascular events that present with atypical, non-classical features, leading to dangerous diagnostic delay. This review provides a practical, evidence-based framework for distinguishing common stroke mimics from true ischemic events, recognizing stroke chameleons in atypical presentations, and making safe, informed decisions regarding thrombolysis when diagnostic uncertainty persists.
Keywords: stroke mimic; stroke chameleon; functional neurological disorder; hemiplegic migraine; posterior circulation stroke; HINTS examination; thrombolysis; emergency neurology; Guillain-Barré syndrome; Miller Fisher syndrome
Authors: Osheik Abuasha Seidi, MB BS, CCST, FRCP, FAAN
Affiliation: Department of Neurosciences, Soba University Hospital and Faculty of Medicine, University of Khartoum, Sudan
Vol. 1, Issue 1 · June 2026 · pp. 29–33