The differential diagnosis between Stroke and Encephalitis from a clinical point of view in some cases can be complicated, making it necessary to resort to MRI diffusion sequences. Three men with acute ischemic stroke (AIS) are presented, all three with suspected encephalitis that were a diagnostic challenge for the clinician. The first case, an AIS in the territory of the right anterior cerebral artery (ACA) that was initially medicated with antibiotic therapy for community pneumonia, and the reappearance of fever and epileptic seizure made us think of a CNS infection. The second case was an infarction in the border territory of the left middle cerebral artery (MCA)/posterior cerebral artery (PCA) with onset of aphasia, fever and agitation accompanied in its evolution by extensive intestinal ischemia with a fatal outcome. The third case, an AIS of the posterior circulation with inaugural headache, vomiting, altered level of consciousness and speech with transient right motor deficit in which the cause of the stroke was a patent foramen ovale (PFO). The three cases correspond to cerebral infarcts that simulate encephalitis in the clinic and in cerebrospinal fluid (CSF): light pleocytosis, proteinorrachia, without identified microorganism. In the literature, there are no studies or clinical series, only exceptional clinical cases of this form of presentation whose pathogenic mechanism is unknown. In these cases, we must always exclude an embolic stroke of undetermined origin (ESUS).

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