Following ischemic stroke, interventions to bring about reperfusion must be implemented within the recognized timeframe; this means that timely clinical recognition of this condition is vital. The process of diagnosis begins with the initial bedside assessment of the patient to be followed by appropriate imaging studies. However, because reperfusion therapy may be attended by significant adverse consequences, and since imaging may be negative for many hours after stroke onset, the clinician must be aware of conditions that mimic cerebral ischemia. Depending on the timing and nature of ancillary testing, stroke mimics can be identified in 3-30% of patients presenting with the acute onset of a neurological deficit. These mimics include metabolic, traumatic, migrainous, neoplastic, endocrine, convulsive, and psychiatric disorders. Interestingly, the nature of these mimics, their frequency of occurrence, and presentation may vary between different geographical regions; however, detailed information regarding such variations is not available at present. This review provides an overview of the conditions that can masquerade as stroke, and includes information that may aid in their early detection or, at the very least, serve to warn the clinician that the patient is presenting with something other than cerebral ischemia.