Stroke remains one of the leading causes of death and long-term disability in the United States, yet thousands of patients each year do not receive a correct diagnosis when they first seek emergency medical care. Researchers continue to identify stroke misdiagnosis as one of the most serious diagnostic errors occurring in emergency departments. In fact, a major systematic review published by the National Center for Biotechnology Information (NCBI) identified stroke as the medical condition most commonly associated with serious harm from diagnostic errors.^1
Studies estimate that approximately 2% to 13% of stroke patients are initially misdiagnosed, with some research placing the overall rate around 9% of all stroke cases.^2,3 The risk increases significantly when patients present with symptoms that do not fit the traditional picture of a stroke.
Most people recognize classic warning signs such as facial drooping, weakness on one side of the body, slurred speech, confusion, vision changes, and difficulty walking. However, recent research shows that patients experiencing dizziness, vertigo, balance problems, nausea, or headaches are far more likely to be misdiagnosed.^4 According to a 2025 review published in Brain Sciences, as many as one-third of vertebrobasilar strokes presenting primarily with dizziness or vertigo may initially be missed.^5
This issue has become increasingly important as healthcare providers see more strokes occurring in younger adults and in patients who do not fit traditional stroke risk profiles. A 2024 study published in the Journal of Personalized Medicine found that the absence of typical stroke symptoms and risk factors was one of the strongest predictors of an incorrect diagnosis.^6
Emergency departments face additional challenges because many conditions can mimic stroke symptoms. Migraines, seizures, inner-ear disorders, low blood sugar, and anxiety-related conditions can all resemble a stroke. Experts estimate that 20% to 40% of suspected stroke cases ultimately turn out to be “stroke mimics.” Nevertheless, physicians must carefully rule out stroke because treatment delays can have devastating consequences.^7
Neurologists often emphasize that “time is brain.” Every minute a stroke goes untreated can result in the loss of millions of brain cells. Treatments such as thrombolytic drugs and mechanical thrombectomy procedures are highly time-sensitive. Delayed diagnosis can mean the difference between a full recovery and permanent disability.
Research has also shown that strokes involving dizziness or vertigo frequently present unique diagnostic challenges. A 2025 study published in BMC Emergency Medicine noted that emergency physicians continue to struggle with identifying ischemic strokes in patients whose primary complaints are dizziness or vertigo, leading researchers to develop new screening tools designed specifically for these high-risk patients.^8
The consequences of a missed stroke can be catastrophic. Patients may suffer permanent brain damage, paralysis, speech impairments, cognitive deficits, loss of independence, or death. An NCBI review found that missed strokes are associated with significantly worse outcomes and that diagnostic errors are particularly common among younger patients and those presenting with atypical symptoms.^1
From a legal perspective, a stroke misdiagnosis may constitute medical malpractice when a healthcare provider fails to meet the accepted standard of care. Examples may include failing to recognize stroke symptoms, delaying diagnostic testing, misinterpreting imaging studies, or failing to consult appropriate specialists. While not every misdiagnosis is malpractice, hospitals, emergency physicians, radiologists, and other healthcare providers may be held accountable when preventable errors cause additional injury or death.
When a stroke misdiagnosis results in permanent disability, families often face substantial medical expenses, rehabilitation costs, lost income, and long-term caregiving responsibilities. If a loved one dies because a stroke was missed or improperly treated, surviving family members may have grounds to pursue a wrongful death claim under South Carolina law.
As hospitals increasingly explore artificial intelligence and advanced screening technologies to improve stroke detection, patient advocates stress that awareness remains the best defense. Recognizing stroke symptoms and seeking immediate medical attention can save lives, reduce disability, and improve outcomes for patients and their families.^9
References
Acosta J, et al. Voice-guided Orchestrated Intelligence for Clinical Evaluation (VOICE): A Voice AI Agent System for Prehospital Stroke Assessment. 2025.
Newman-Toker DE, et al. Diagnostic Errors in the Emergency Department: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), NCBI Bookshelf.
Newman-Toker DE, et al. The Development and Endorsement of a Performance Measure for Stroke Misdiagnosis in the Emergency Department. Qual Manag Health Care. 2024.
Abedi V, et al. Machine Learning-Based Prediction of Stroke in Emergency Departments. Clinical Medicine Insights. 2024.
Newman-Toker DE, et al. Studies of missed stroke presentations involving dizziness and vertigo.
Tarnutzer AA, et al. Diagnostic Errors in the Acutely Dizzy Patient—Lessons Learned. Brain Sciences. 2025.
Jalali R, et al. The Absence of Typical Stroke Symptoms and Risk Factors Represents the Greatest Risk of an Incorrect Diagnosis in Stroke Patients. Journal of Personalized Medicine. 2024.
National Library of Medicine. Stroke Mimics and Diagnostic Challenges in Emergency Medicine.
Zhang Y, et al. Diagnostic Performance of a Novel Clinical Score for Predicting Acute Ischemic Stroke in Emergency Department Patients Presenting with Vertigo or Dizziness. BMC Emergency Medicine. 2025.
