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5 Health Conditions That Can Cause Stroke-Like Symptoms

Regardless of the cause, doctors say it’s important to seek immediate medical attention


spinner image illustration of a woman with red hair removing her glasses and rubbing her forehead due to migraine headache stroke mimic
Aleksei Morozov / Getty Images

Sudden numbness or weakness in the face, an arm or leg; trouble speaking, seeing, or walking — these are all classic symptoms of a stroke, or what’s often thought of as a brain attack.

In the same way blood flow to the heart muscle is blocked during a heart attack, a stroke occurs when something prevents blood from making its way to the brain; a stroke can also happen when a blood vessel in the brain bursts. Either way, the brain is damaged. 

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At least 20 percent of the time, however, all or some of the same symptoms are not signs of a stroke; they’re signs of what’s known as a stroke mimic. Conditions that can come off as a stroke include seizures, migraines, and high or low blood sugar.

“Symptoms in stroke mimics can be very similar to an actual stroke,” says Jayne Zhang, M.D., an assistant professor of neurology at Johns Hopkins School of Medicine. “It’s very difficult to differentiate, so it’s important to go to the hospital when you have these symptoms — regardless of what it is. We don’t ever want to miss a stroke.”    

Strokes can be treated, but time is of the essence. Each moment a stroke goes untreated, the nervous tissue in the brain is irreversibly damaged. That’s why it’s important to call 911 if you or a loved one experiences even stroke-like symptoms.

“There is a very narrow window — up to four and a half hours from the onset of symptoms — to get to the ER for treatment,” Zhang says. “A lot of people miss out on the opportunity because they don’t know they need to come in within that time frame or as soon as possible.”

But what if you’re that 1 in 5 who is experiencing a stroke mimic and you receive treatment for a stroke? One study published in 2021 in Annals of Medicine found that a significant number of patients who received thrombolysis — a clot-busting treatment for ischemic stroke, by far the most common kind of stroke — were actually experiencing a stroke mimic.

“It’s important to go to the hospital when you have these symptoms — regardless of what it is. We don’t ever want to miss a stroke.”

— Jayne Zhang, M.D., assistant professor of neurology at Johns Hopkins School of Medicine

There is a risk that misdiagnosis and inadvertent treatment may lead to serious injury, like internal bleeding. However, “the overall benefit is greater than the risk of bleeding in the setting of a stroke mimic,” says Deepak Gulati, M.D., a neurologist who specializes in treating stroke patients at the Ohio State University Wexner Medical Center. That’s especially true, he adds, “given the fact that stroke is a leading cause of disability and fifth common cause of death.”

In other words: With stroke mimics, it’s best to err on the side of caution, particularly for older people, since age is a risk factor for stroke. “The incidence of stroke is common in people over 50, and goes up significantly after the age of 60,” Gulati says. This is “due to increasing prevalence of conditions known to increase stroke risk — for example, high blood pressure, obesity and diabetes.”

5 common stroke mimics

1. Seizure

With a seizure, nerve cells in the brain send out sudden, excessive, uncontrolled electrical signals, causing changes in awareness, thinking, behavior or body movement. There are two types of seizures: A generalized seizure can affect both sides of the brain, and what’s known as a focal seizure affects one side of the brain.

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Like a stroke, a seizure “can cause weakness, numbness, gaze deviation and trouble with speech,” Gulati says. But unlike a stroke, “seizures can cause jerking or shaking of the body before or after these symptoms.”

2. Brain tumor

A brain tumor is an abnormal mass of tissue in which cells grow and multiply uncontrollably. Brain tumors can be benign (noncancerous) or malignant (meaning cancerous). Either way, they can mimic a stroke — especially gliomas, the most prevalent type of malignant brain tumor in adults, and meningiomas, the most common benign brain tumor.

Depending on the location of the tumor, symptoms may include severe headaches, difficulty thinking or speaking, vision loss, and nausea or vomiting.

One tip-off you’re experiencing this particular type of stroke mimic and not an actual stroke? “Brain tumors grow over time,” Zhang says. “You can have progressive weakness on one side or the other, depending on whether the tumor is on the right side of the brain or the left.” A stroke, on the other hand, “happens suddenly — like a heart attack.”

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3. Migraine

Migraines are characterized by pounding pain on one side of your head, which may seem very stroke-like, especially if it’s your first migraine. One clue it isn’t a stroke: Migraines tend to send advance notice of their impending arrival. Around 24 hours before getting a migraine, for instance, you may experience food cravings, uncontrollable yawning or fluid retention; or you may see what look like heat waves, if not flashing or bright lights right before a migraine (what’s known as an aura).

A “complicated migraine,” on the other hand, is trickier to distinguish from a stroke. The headache is accompanied by significant neurological symptoms such as paralysis on one side of the body or an inability to speak or understand speech. “When someone has a complicated migraine, they start out with a headache, but that gradually evolves to weakness or numbness on one side of the body, very much similar to a stroke,” Zhang says.

While strokes are sudden, a complicated migraine “is what we call a gradual onset with a slow march,” Zhang says. “If a patient has experienced this before, and it’s similar to their usual migraines, then we know it’s a migraine and not an acute stroke.” 

4. High or low blood sugar

Someone with diabetes who’s experiencing an episode of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) might very well appear to be having a stroke.

If your blood sugar is low, you may feel shaky, jittery, dizzy, lightheaded or confused; if it’s very low, you could lose consciousness or have a seizure. If your blood sugar is high, you may feel tired, weak, headachy; your vision may become blurred. How to know if either of these is a stroke versus a stroke mimic? The answer is in the blood work. “The symptoms get better with resolution of high or low blood glucose,” Gulati says. Not so with a stroke.

5. Bell’s palsy

With Bell’s palsy — the most common cause of temporary facial paralysis — one of the nerves that control muscles in your face becomes injured or stops working the way it should and as a result one side of your face suddenly becomes weak or paralyzed. Similar to other stroke mimics, Bell’s palsy comes on slowly, over hours or days. Other symptoms: a drooping eyebrow and mouth; difficulty closing an eye; drooling from one side of the face.

One telling clue it’s Bell’s palsy and not a stroke can be found in the forehead, of all places. “Bell’s palsy involves the whole face, including the forehead,” says Gulati. “Facial weakness caused by stroke usually involves the lower face and spares the forehead.”

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