Neftaly: Stroke Mimics Presenting to Emergency Departments

Introduction

When patients present to the Emergency Department (ED) with sudden neurological symptoms, stroke is often the first and most urgent consideration. However, a significant proportion of these cases turn out to be stroke mimics—conditions that present with similar symptoms but are not caused by cerebrovascular events.

At Neftaly, we support healthcare professionals and systems to strengthen acute neurological care. Recognizing and managing stroke mimics effectively is vital for patient safety, appropriate resource use, and improved emergency care outcomes.

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What Are Stroke Mimics?

Stroke mimics are non-stroke conditions that present with symptoms resembling an acute stroke, such as:

• Sudden weakness or numbness
• Slurred speech
• Vision disturbances
• Loss of balance or coordination
• Altered consciousness

Stroke mimics can account for up to 30%–40% of suspected stroke presentations, particularly in busy or resource-limited EDs.

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Common Stroke Mimics

Condition	Mimicking Symptoms
Seizures (post-ictal state)	Confusion, weakness, altered awareness
Hypoglycemia	Slurred speech, hemiparesis, confusion
Migraine with aura	Visual changes, numbness, aphasia
Functional neurological disorders	Motor/sensory symptoms without organic cause
Brain tumors	Focal deficits, headache
Vertigo or vestibular disorders	Imbalance, dizziness, nausea
Infections (e.g., encephalitis)	Fever, confusion, seizures
Hypertensive encephalopathy	Visual changes, seizures, headache

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The Importance of Differentiating Stroke from Mimics

???? Why It Matters:

• Avoiding unnecessary thrombolysis: Stroke treatments like thrombolytics carry serious risks if given inappropriately.
• Optimizing resources: Reducing unnecessary use of stroke protocols, beds, and imaging.
• Timely diagnosis of alternative conditions: Some mimics require immediate but different interventions (e.g., seizure management, glucose correction, or infection control).

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Clinical Challenges

• Stroke and its mimics often present indistinguishably, especially in the early stages.
• Time pressure in emergency settings increases the risk of misdiagnosis.
• Limited access to neurology consultation can affect decision-making, particularly in smaller or rural hospitals.

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Neftaly Solutions

Neftaly provides capacity-building and system-level support to help EDs improve accuracy and response when dealing with suspected strokes:

???? Training & Education

• Specialized training for ED staff on differentiating strokes from mimics
• Use of structured tools like the ROSIER scale, FAST-ED, and NIH Stroke Scale
• Simulated case scenarios for rapid decision-making

???? Protocol Development

• Implementing standardized stroke triage algorithms including mimic screening
• Guidelines for appropriate imaging use (CT, MRI, EEG)
• Decision support tools integrated into electronic health records

???? Access to Expertise

• Support for tele-neurology services in remote or under-resourced settings
• Building multidisciplinary stroke teams including neurologists, emergency physicians, and radiologists

???? Monitoring & Improvement

• Data collection on false-positive stroke alerts
• Clinical audits and feedback loops for continuous learning
• Patient outcome tracking for those diagnosed with mimics

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Case for Action

Failure to accurately identify stroke mimics can lead to:

• Delayed diagnosis of the actual condition
• Inappropriate treatment with potential harm
• Increased healthcare costs
• Patient and family anxiety or mistrust

An empowered and well-trained emergency care team is the first line of defense in making the correct diagnosis—fast.

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Conclusion

Distinguishing strokes from mimics is a critical skill in emergency care. Neftaly works with hospitals, clinicians, and healthcare systems to build capacity, develop protocols, and improve emergency neurological care—ensuring that every patient receives the right diagnosis and the right care, at the right time.

Let Neftaly help your facility strengthen its stroke response systems, reduce diagnostic errors, and deliver better outcomes for all neurological presentations.