Commonly encountered stroke mimics

1. Seizure — May mimic in  both ictal and post ictal presentations 

• DWI: Restricted diffusion predominantly in the cortical grey matter with sparing of subcortical white matter.
• Perfusion Imaging: Increased perfusion in affected regions, differentiating it from ischemia.
• FLAIR: Gyral hyperintensity due to cortical edema.
• Contrast-Enhanced MRI: Gyral enhancement in later stages.

• DWI: No diffusion restriction (key feature to exclude stroke).
• T2/FLAIR: Transient hyperintensities in the cortex or subcortical white matter, particularly in the centrum semiovale or brainstem.
• Perfusion Imaging: Occasionally shows hypoperfusion in the corresponding region, mimicking ischemia.

• Restricted diffusion may be seen in the cerebral cortex (particularly the occipital lobes), corona radiata and centrum semiovale
• T2/FLAIR: Hyperintense signal in the same regions, reflecting metabolic disturbances.
• The cause of diffusion restriction is thought to be energy failure due to lack of glucose, excitotoxic edema, and/or asymmetric cerebral blood flow

• DWI: Mild or absent diffusion restriction (helps distinguish from infarction).
• T1+C (Contrast-Enhanced): Irregular or ring enhancement.
• T2/FLAIR: Peritumoral edema, often disproportionate to lesion size.

• DWI: Cortical or subcortical restricted diffusion in non-vascular patterns.
• T2/FLAIR: Patchy or confluent hyperintensities in the grey and white matter.
• Perfusion Imaging: Variable findings depending on etiology.

• Conversion disorder
• Somatization
• Non organic
• Non- neurological
• MRI: Normal imaging across all sequences, with clinical findings often inconsistent with radiological patterns.