Table 2 Common stroke mimics in adolescents and young adults

Seizures (Post ictal state/Todd’s Paralysis)

Sudden onset of unilateral weakness or focal neurological impairment following a seizure activity.

Transient in nature (usually resolved within 24–48 h), history of seizure activity, postictal disorientation.

Migraine with Aura

Visual disruptions, verbal difficulties, sensory abnormality.

Gradual onset and the symptoms are accompanied by unilateral headache. Resolves spontaneously.

Functional neurological disease (FND)

Abrupt onset of neurological symptoms include weakness, paralysis, trouble speaking.

Clinical findings lack in appropriate localization. Typically, with a history of psychological stressors or disorder.

Hypoglycemia

Focal neurological impairments, weakness, difficulty in speaking, and disorientation.

There can be the presence of sympathetic activity symptoms such as palpitations and sweating. Rapid administration of glucose results in quick recovery.

Electrolyte imbalance

Weakness and muscle cramps

Negative neuroimaging. Weakness doesn’t fit the pattern of a stroke. Typically, hypokalemia-associated. Resolution by normalizing electrolytes

Bell’s Palsy

Unilateral facial weakness involving the forehead also

Gradual onset, absence of other neurological symptoms.

Acute Vestibular Syndromes

Vertigo, gait disturbances, nausea, vomiting

Positive head-impulse test (a rapid corrective movement of the eyes when the head is turned), nystagmus. Absence of weakness and other neurological features.