Stroke affects approximately 800,000 people in the United States each year and is the fourth major leading cause of adult mortality.1 Rapid diagnostic evaluation and prompt treatment are important to prevent death and disability from a stroke. The literature suggests that up to 30% of patients who present with acute onset of neurologic symptoms were found to have a stroke misdiagnosis. In addition, the safety of thrombolytic therapy for stroke mimics has not been fully studied. Although patients with acute stroke can benefit substantially from thrombolytic therapy, misdiagnosis of acute stroke can carry serious implications, and it is imperative that radiologists make a prompt and accurate diagnosis. Combining various imaging techniques and interpreting imaging findings in appropriate clinical contexts will help with selection of appropriate therapy.