Think you’re having a stroke? It could be something else

Brain Health

by Baylor Scott & White Health

Dec 1, 2023

Strokes are a serious health condition that requires immediate medical attention. Time is of the essence when it comes to treating a stroke, so it's important to recognize the signs and symptoms as soon as possible.

But there are other conditions that show symptoms similar to a stroke—what we call stroke mimics. According to the National Institutes of Health, stroke mimic account for almost half of hospital admissions for suspected strokes, and some of these people receive treatment for strokes.

How do you know if someone is having a stroke or another condition that looks like a stroke? Let’s take a look at both disorders.

What’s the difference between a stroke and a stroke mimic?

A stroke occurs when there is a blockage in a blood vessel that supplies blood to the brain, typically caused by a blood clot. Immediate treatment is crucial, and it often involves clot-busting medication and, in some cases, surgery. There's also another type of stroke caused by bleeding due to a ruptured blood vessel. The key to remember here is: Time is brain! If you experience stroke symptoms, it's vital to call 911 and get to the hospital quickly. Do not try to drive yourself.

A stroke mimic refers to a medical condition that has symptoms like those of a stroke but is caused by something other than a blood clot or bleeding in the brain. Some can imitate the signs of a stroke, leading to confusion or misdiagnosis. For instance, migraines, low blood sugar seizures and inner ear disturbances can manifest symptoms that resemble those of a stroke, such as sudden weakness, numbness, confusion, difficulty speaking or loss of balance.

Other stroke mimics include:

  • Hyperglycemia (high blood sugar)
  • Intoxication from alcohol or drugs
  • Certain types of cancers can increase the risk of stroke by making blood more likely to form clots
  • Urinary tract infections
  • Significant stress

Recognizing the symptoms

As time is crucial to receive the right care, learning the symptoms of a stroke can be lifesaving. An easy way to remember them is the BE FAST acronym:

  • Balance: Rapid onset of balance problems
  • Eyes: Double vision or loss of vision in one or both eyes
  • Face: One side of the face droops or is numb
  • Arm: One arm is weak
  • Speech: Changes in speech, such as slurred words or speaking gibberish
  • Time: Time to call 911

You may also notice other symptoms, including:

  • Vertigo (a spinning sensation)
  • Facial droop - Leg weakness
  • Sensory changes, like numbness

Stroke mimics also can present with some of these symptoms, which can make it difficult for someone without medical training to tell whether it’s a stroke or stroke mimic. That’s why any of these symptoms, whether experienced individually or in combination, is a reason to call 911.

How do doctors determine if someone is having a stroke or a stroke mimic?

Since it can be challenging for most people to tell the difference between strokes and stroke mimics, the best action is to get to a doctor as soon as possible. Stroke mimics are still medical emergencies because they indicate that the brain is not functioning normally, regardless of the underlying cause.

Physicians rely on medical evaluations to discern the difference. There are subtle clues, such as drowsiness, agitation and fever that can help medical providers consider other potential causes, such as an infection.

In the emergency room, patients with a possible stroke will have a CT scan of the brain. This, coupled with the patient's medical history and examination, helps medical professionals decide on appropriate treatment.

An MRI scan can also give a more detailed picture of the brain, as well as an MR angiogram (MRA) to visualize blood vessels.

When an acute stroke is suspected, doctors will treat with medication for a blood clot.

What’s the relationship between strokes and stroke mimics?

The risk of an actual stroke depends on various factors. In general, the most significant risk factors for strokes include hypertension (high blood pressure), diabetes, high cholesterol, smoking, atrial fibrillation (an irregular heart rhythm), obesity and a history of prior strokes.

Some types of cancers can increase stroke risk by thickening the blood and making it more prone to clot formation. Patients with migraines also have an increased risk of stroke, so those with migraines should discuss stroke risk reduction with their healthcare providers.

If you have a family history of stroke, build a relationship with your primary care physician who can monitor your health and highlight how to reduce your risk. It's better to err on the side of caution when someone is experiencing symptoms that resemble a stroke. Seeking immediate medical help is vital, as timely intervention can significantly impact the outcome and reduce the risk of complications, regardless of whether it's a stroke or a mimic.

Understanding risk factors can lead you to make changes to help prevent a stroke. Learn your risk for strokeand take the first step to a healthier you.

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