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The correct diagnosis of AIS was made only between 1h and 72h after hospital arrival. Four patients presented a vertebrobasilar stroke. None of the patients received acute stroke revascularization therapy despite two of them being in the time window for such treatment. Acute ischaemic stroke presentation can infrequently resemble an ACS. In cases of negative cardiac work-up, a central origin of chest pain should be considered, especially in the presence of subtle other neurological symptoms or signs. Appropriate diagnosis of stroke could