Which of the following is NOT a common stroke mimic clinicians must differentiate from acute ischemic stroke?

• A. Hypoglycemia
• B. Seizure/postictal state
• C. Migraine with aura
• D. Pulmonary embolism

Answer: (D)

Understanding stroke mimics is essential in the acute setting. A stroke mimic is a condition that can produce sudden neurological symptoms similar to an ischemic stroke, leading clinicians to differentiate it quickly from true stroke. The most classic mimics are metabolic or neurologic in origin: low blood glucose can cause weakness, confusion, or focal deficits; seizures and the postictal state can leave temporary focal weakness or speech problems that look like a stroke; and migraine with aura can produce unilateral sensory or speech symptoms that resemble an ischemic event.

Pulmonary embolism, while dangerous and presenting with chest pain, shortness of breath, and fast heart rate, does not typically manifest with the sudden focal neurologic deficits that mimic stroke. It’s primarily a cardiopulmonary issue, not a neurologic deficit pattern seen in stroke like the other examples. So it does not fit as a common stroke mimic in the differential when evaluating acute neurological symptoms.