Makindo Medical Notes

🧠 Introduction

• “Stroke mimics” are conditions that resemble stroke at first presentation, while “stroke chameleons” are strokes presenting atypically, imitating other diseases.
• ⏱️ Because stroke therapy is time-critical, some mimics are thrombolysed before the true diagnosis becomes clear.
• 🧩 Differentiating true stroke from mimics is one of the most challenging emergency skills in acute medicine.
• Recognising both mimics and chameleons improves diagnostic accuracy and patient safety.

⚡ Factors Increasing the Likelihood of True Stroke

Certain features make a vascular event more likely than a mimic 👇

• 🚀 Sudden onset of focal neurological deficit
• 🕐 Clear time of onset
• ❤️ Atrial fibrillation or embolic risk factors
• 👴 Older age group
• 💉 Vascular risk factors: hypertension, diabetes, smoking, hyperlipidaemia
• 🧠 Negative neurology (loss of function rather than abnormal movement/sensation)
• 🩸 Deficit pattern matching a vascular territory

🚑 Common Stroke Mimics

Conditions that can look like a stroke — always worth remembering these in the acute setting.

🎭 Stroke Chameleons — True Strokes Masquerading as Other Diseases

Strokes with atypical presentations often lead to misdiagnosis and treatment delay. Remember: not all strokes look like strokes.

📚 References & Further Reading

• Fernandes PM, Whiteley WN, Hart SR, et al. Strokes: Mimics and Chameleons. Practical Neurology 2013;13:21–28.

💡 Teaching tip: In hyperacute settings, “treat as stroke until proven otherwise” — missing a treatable infarct has greater harm than treating a mimic. However, always check glucose, temperature, infection markers, and electrolytes before thrombolysis.