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Stroke mimics are conditions that resemble acute ischemic stroke, posing a major diagnostic challenge in time-sensitive care. Accurate differentiation is essential to prevent unnecessary thrombolysis, reduce costs, and avoid complications. Clinical assessment, scoring systems, and neuroimaging-particularly MRI-are key to improving diagnostic accuracy. This article reviews common stroke mimics such as seizures, migraine, metabolic disorders, demyelinating diseases, and tumors, emphasizing their clinical and imaging features. Practical imaging strategies are also provided to enhance diagnostic accuracy.