Caruso P and Manganotti P
Stroke is one of the leading cause of disability and death all over the world with a time dependent course and prognosis; during ages different new advances in acute treatment have changed the emergency approach of this cerebrovascular diseases. More rapidly the symptoms are recognized and more prompt thrombolysis treatment may consent vessel recanalization and neurological deficit regression. Early diagnosis is mandatory; unfortunately conditions that can mimic a focal neurological deficit are common in the acute stage. Stroke mimics can account for up to 5% of all acute stroke presentations. Mimics are more frequent in those under 50 years of age, without any particular medical history. The rate of false-positive diagnoses of ischemic stroke labeled “stroke mimic” ranges from 1.3% to 25% in patients not treated with thrombolysis, among all mimics “psychogenic stroke” are increasing in the last decades. In the emergency department is quite difficult to discriminate real stroke from psychogenic stroke mimic but physicians have to decide in a short period which treatment start quickly. Our aim is to review the neurological signs in the rapid short examination in the emergency in order to define stroke mimic from real stroke and the most appropriate approach.