Stroke chameleons refer to a group of syndromes that initially are not diagnosed as cerebrovascular events. Afterward, they are found to represent a stroke. The primary purpose of this study was to report on AIS patients with chest or epigastric pain of central origin, clinically resembling an ACS.

A prospective list was kept of AIS patients admitted to our institution with stroke symptoms appearing as an ACS on the first clinical evaluation. Clinical and radiological features, delay correcting diagnosis, stroke etiology, and 3‐month functional outcome were reviewed for each identified patient. The researchers mainly extracted the data from the ASTRAL.

Five AIS patients presenting mainly with chest or epigastric pain leading to a wrong ACS diagnosis were identified. The cardiac evaluation showed minor electrocardiogram changes in two patients and isolated troponin elevation in one, subsequently shown to be of non‐coronary origin.

The study concluded with findings that acute ischaemic stroke presentation can infrequently resemble an ACS. A central origin of chest pain should be considered, especially in subtle other neurological symptoms or signs. Therefore an appropriate diagnosis of stroke could avoid treatment delays and improve outcomes.