The proper diagnosis of stroke requires profound clinical knowledge, which cannot be expected from lay persons or ambulance

paramedics. On one hand simplified but specific signs are needed for public campaigns, on the other hand stroke recognition in prehospital settings cannot be simplified further info without losing a substantial number of patients. Obviously, signs such as ‘Vertigo’ and ‘Somatosensory Deficits’ target much more patients with stroke but coincidently capture more stroke mimics and thereby dilute the message and burden the healthcare system. It is important to recognise that sudden neurological symptoms need expeditious referral and neurological expertise, because sudden neurological diseases other than stroke may represent emergencies as well. Messaging in public awareness programmes is therefore subject to more complex considerations. Besides catchy wording, frequency of symptoms, capture rates and positive and negative predictive values, the capacity

and readiness of regional healthcare systems to cope with stroke mimics will enhance public campaigns. Supplementary Material Author’s manuscript: Click here to view.(1.5M, pdf) Reviewer comments: Click here to view.(170K, pdf) Acknowledgments The authors thank especially Kristin Brüderlein, Ines Federow, Doreen Niemann, Gesine Makowei, Frances König, Jan Burmeister, and Carla Biedermann for organisational aspects. In particular, Sabine Rösner and Susanne Zielke spent a lot of effort in realising the entire workflow. Elmar Beck (Anfomed GmbH, Möhrendorf, Germany) programmed the web-based data bank as well as hosted the data. Footnotes Contributors: The concept

of the present analysis was developed by MK. MK and UG analysed the data. UG conducted the statistical analysis. MK, UG and CT were responsible for the development of the manuscript. AR initiated the sifap1 study. GJ, TT, JP, CT participated in the data acquisition. MK, UG, GJ, TT, CK, RS, PJ, BN, AR and CT were responsible for the intellectual discussion, review, analysis and interpretation of the results. MK, UG, GJ, TT, CK, RS, PJ, BN, AR and CT contributed with substantial and Entinostat important intellectual content in drafting and reviewing the manuscript. Funding: The sifap1 study (Stroke in Young Fabry Patients, http://www.sifap.eu; http://www.clinicaltrials.gov: No. NCT00414583) has been supported partially by an unrestricted scientific grant from Shire Human Genetic Therapies. Competing interests: None. Ethics approval: The design of the study was approved by the ethics committee of the Medical Association Mecklenburg-Vorpommern (board 2), Medical Faculty, and University of Rostock. Approval of the local ethics committees was obtained in all participating centers. The study was registered in http://www.clinicaltrials.gov (No. NCT00414583). Provenance and peer review: Not commissioned; externally peer reviewed.