Introduction Outcomes in acute stroke, and its mimics, are time dependent. Accurate and rapid diagnosis of all patients presenting to a stroke service is essential.

Methods Prospective data regarding diagnosis and management of patients admitted to a tertiary referral hospital with a provisional diagnosis of stroke were collected over a 1 month period by a neurology registrar.

Results 65 patients were seen during 17 working days; 37 were referred and 28 proactively retrieved. After neurology review the provisional diagnosis of stroke was revised in 60%. The most common alternative diagnoses (in order of frequency) were infection, functional disease, migraine, seizures, spinal cord pathology and peripheral vestibular disease. 27 of the patients (42%) were discharged the same day. The remainder were admitted to stroke (17), medical (11) surgical (1) and neurology (2) wards.

Conclusion We demonstrated that patients presenting with acute neurological symptoms may benefit from early review by a neurology specialist doctor. Rapid and accurate identification and treatment of patients with stroke and non-stroke diagnoses, which are often eminently treatable, ensures that both groups receive the correct treatment and that unnecessary medication and admission is avoided.