Objective: The purpose of the study is to assess the diagnostic accuracy of diffusion- weighted magnetic resonance imaging (MR-DWI) performed in the first six hours after symptom onset in patients mimicking stroke. Material and Methods: The patients included in the study were those in whom the non-contrast computed tomography (NCCT) scan failed to depict the reason for the new stroke-like symptoms and/or the patients for whom additional information was needed in order to plan their therapy. Patients who had an imaging technique performed within six hours after presenting in the ED were included. Final diagnosis of stroke was derived from any of the positive results of MRI, NCCT, data derived from patient's files or telephone follow up, asking whether the patient experienced a stroke attack within three months after index ED visit. Results: Data of 78 patients were analyzed and ischemic stroke was detected in 17 patients. The sensitivity and specificity of MR-DWI were 100% (95% CI: 80-100) and 100% (95% CI: 94-100), respectively. The positive and negative predictive values for MR-DWI were 100 (95% CI: 80-100) and 100 (95% CI: 94-100), respectively. Conclusion: MR-DWI is a fast and valuable imaging modality in the ED. The results of the test can be used in daily practice of busy EDs. The test can change the management strategy of NCCT negative patients with new stroke-like symptoms when a decision about patient treatment requires additional information.