BMC Neurology

Mélo Silva Júnior de et al. BMC Neurology
(2023) 23:273
https://doi.org/10.1186/s12883-023-03327-y

Open Access

RESEARCH

Different words for stroke: the same
concept? an analysis of associated symptoms
and intended reaction in Brazil
Mário Luciano de Mélo Silva Júnior1,2,3* , Ana Gabriella Camelo Oliveira4 , Weslley Medeiros Gois4 ,
Matheus Franco Andrade Oliveira5 , Lourdes Maria Dantas de Góis6 , Lucas Pereira Ferreira6 and
Marcos Vinícius de Souza Vilanova3
Abstract
Background Different names for stroke might mislead physicians and emergency medical service workers. This study
aimed to assess the different words for stroke in Brazil and both intended response and related symptoms associated
with those names.
Methods Cross-sectional study enrolling healthy individuals from urban areas in Northeast of Brazil for an openended survey. We presented a typical clinical case of a stroke (an elderly who had sudden onset of hemiparalysis and
slurred speech) and asked “what is happening?”, “what would you do?” and “which other symptoms could happen in
this condition?”.
Resuts From 1,475 interviewed individuals, 1,220 (82,7%) recognized the scenario as a stroke. There were 3 words
to correctly identify (based on correct intended response and spontaneously evoked associated symptoms) the
stroke, which were “AVC” (acronym for cerebrovascular accident, in Portuguese), “derrame” (spillage) and “trombose”
(thrombosis). There were significant differences among them concerning demographic, economic, educational and
geographical aspects, but there was no difference according to the intended reaction among them. The most cited
associated symptoms (excluding those present in the case) were impaired consciousness (10.6%), headache (8.9%)
and dysesthesia (7.7%). “Aneurisma” (aneurism) was also cited, by 3 individuals.
Conclusion There are at least three words for stroke in Portuguese (“AVC”, “derrame” and “trombose”); they were
similar in terms of correct intended responses and spontaneously cited accompanying symptoms. Stroke campaigns
should apply different names to reach a broader audience and to improve stroke recognition.
Keywords Cerebrovascular disorders, Stroke, Signs and symptoms, Health knowledge, attitudes, practice, Surveys
and questionnaires

*Correspondence:
Mário Luciano de Mélo Silva Júnior
mariomelosjr@gmail.com
1
Medical Sciences Center, Division of Neuropsychiatry, Universidade
Federal de Pernambuco, Recife, Pernambuco, Brasil
2
Neurology Unit, Hospital da Restauração, Recife, Pernambuco, Brasil
3
Medical School, Uninassau, Recife, Pernambuco, Brasil

4

Universidade Federal de Sergipe, curso de graduação em Medicina,
Lagarto, Sergipe, Brasil
5
Escola Bahiana de Medicina e Saúde Pública, curso de graduação em
Medicina, Salvador, Bahia, Brasil
6
Universidade Potiguar, curso de graduação em Medicina, Natal, Rio
Grande do Norte, Brasil

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Introduction
The first step in the stroke chain of survival is recognizing the stroke symptoms and subsequently transporting
the patient to a stroke center. This prehospital phase is
the longest in the first hours of stroke [1]. Populational
knowledge campaigns [2] and training the emergency
medical service (EMS) members [3] may improve stroke
recognition and minimize the time between symptoms
onset and both stroke center arrival and reperfusion
therapy delivery.
A chief cause for non-recognizing a stroke is atypical
presentation, mainly posterior circulation syndromes and
language deficits [4]. Studies have shown that the rate of
undiagnosed strokes may dimmish whether one is applying wider algorithms, such as the BE-FAST (balance, eye,
face, arm, speech, time) more than the FAST. This can be
applied not only to health professionals but to the general
population.
Some sociodemographic characteristics, like more
educational years, better economic status, and previous
experiences may influence the patient’s and bystander’s
ability to recognize [5] and properly respond to a stroke
[6]. However, other factors may play roles in this process,
such as communication issues among patient/bystander
and EMS dispatchers. Previous studies with the Spanishspeaking population showed at least 8 words to name a
stroke [7]; in Portuguese, there were up to 28 [8] names
for it. But it is not clear if these different words are related
to the idea of the stroke itself or to other medical conditions, such as myocardial infarction, intoxications, or a
malaise [9]. The impact of this kind of misconception on
help-seeking behavior is likewise unknown. On the other
hand, identifying the clinical significance of those terms
and applying them in stroke awareness campaigns on lay
media could maximize knowledge acquisition and reach
broader audiences.
We conducted an exploratory study in the Northeast
of Brazil, which presented a typical stroke clinical case to
volunteers. We aimed to identify the different words used
to name a stroke in Brazil, applying an open-ended survey; we assessed the concept of stroke through both the
cited accompanying symptoms and intended reactions to
this hypothetical scenario.

what she tries to say), followed by 9 open-ended questions about it, besides the participant’s demographical data. From those questions, 3 are presented here: (a)
“what do you think is happening to your aunt?”, (b) “in
this situation what would you do?” and (c) “which other
symptoms could happen in this condition?”.
Interviewers were trained medical undergraduate students. They approached passers-by in high-flow public
spaces, such as squares, bus/subway stations, and street
markets (similar to previous studies [8, 12, 13]), of predetermined cities and invited those individuals to enroll
in the study, configuring a quasi-random sample. The
answers were completely spontaneous without any suggestion or interference from the interviewers. Sample
size was not calculated prior to data collection. The
responses were tape-recorded and transcribed to a digital registry. The volunteer could provide more than one
answer to each question.
Inclusion criteria were being 18 years old or more;
exclusion criteria were being tourists, having communication problems that impaired the interview or a personal history of stroke.
All Brazilian ethical standards were followed, and all
participants gave their consent before the study (approval
number: 4.299.487).

Methods
This was a cross-sectional study, which data were collected from October 14th to November 30th, 2020. Our
collection tool was developed by us, based on previous
studies [10, 11]. It consisted of a typical clinical case of
stroke that was read to the participants (You are in a conversation with your aunt and suddenly she presents difficulty speaking and walking. While you try to help her,
you notice that her face is drooping, there is some weakness in her right arm and leg and you cannot understand

The last question we examined was “Beside those symptoms presented (dropping face, weakness in arms and
legs, troubled speech), could you cite other symptoms
related to this condition?”.
The answers were grouped by the main author (MLM,
blinded to the recognition and reaction answers) in 8
axes, as follows: impaired consciousness or cognition,
headache, dysesthesia or paresthesia, cardiac-related,
dizziness or incoordination or imbalance, visual problems, seizures and dysautonomia.

Recognition and reaction to stroke

After being exposed to the clinical case, individuals were
asked “what do you think is happening?”. All answers
were registered, but those we considered correct during
the study design were “AVC” or “acidente vascular cerebral/encefálico” (cerebro/encephalic-vascular accident),
“derrame” (spillage), and “aneurisma” (aneurism). “Trombose” (thrombosis) was not expected by us in the study
design phase, but was added as a correct answer once it
met our criteria of proper both intended response and
cited accompanying symptoms.
Then, we questioned “what would you do in this situation?”. Correct responses were calling an ambulance
(SAMU, the acronym for Mobile Emergency Care Service
in Portuguese, equivalent to EMS) or taking the patient
to a hospital. Other answers were considered incorrect.
Associated symptoms

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Answers such as somnolence, confusion, disorientation, fainting, and memory issues were labeled as
impaired consciousness or cognition. We considered
cardiac-related answers like tachycardia, dyspnea/
breathlessness, chest pain, and high blood pressure.
Visual problems were considered diplopia, blindness and
impaired seeing. Sweating, chilling, vomiting, paleness
and sphincter relaxation were labeled as dysautonomia.
The other axes are self-explained.
Statistical analysis

Data were analyzed to assess the concepts associated
with the different words used to describe the stroke. This
was done through an analysis of the intended reaction
(question b) and of the symptoms spontaneously evoked
(question c).
The four most frequently cited responses (AVC, derrame, infarto and trombose) were analyzed according to
sociodemographics (age, formal school years, sex, race,
having private health insurance), geographic site of data
collection (state’s capital, and Bahia state, the state with
the highest number of respondents), intended reaction
to the stroke scenario and each of the 8 axes of evoked
related symptoms.
For qualitative variables, data are presented as absolute
numbers and percentage, and Fisher test was applied; size
effect is presented as relative risk and 95% confidence
interval. For quantitative variables, data are presented
as median and interquartile range (IQR), and the MannWhitney test was applied. All variables were handled as
dichotomic, except age and school years.
We provide the results of all correct responses (as a
whole) to act as a reference, and each specific name was
compared to all other correct names. Data from those
who did not recognize the clinical case as stroke are not
presented here (except for the “infarto” group).
Data were assessed in the IBM Statistical Package for
the Social Sciences version 25 for MacOS. Missing data

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were < 0.1% and were excluded from the specific analysis. The significance level of all statistical tests was set at
p < .050 (two-tailed).

Results
The volunteers were recruited in 12 cities of Brazil’s
Northeast (median 657,000 [IQR = 104,000-958,000]
inhabitants per city), including 6 (Maceió, Natal, Recife,
Salvador, São Luiz, Teresina) out of the 9 states’ capitals.
Table 1 shows the demographic and geographic characteristics of our sample.
Various responses were given to the question “what do
you think is happening?”. The answers considered correct were “AVC” or “acidente vascular cerebral” (n = 823),
“AVE” (n = 21), “derrame” (n = 390), “trombose” (n = 39)
and “aneurisma” (n = 3), totaling 1,220/1,475 (82,7%).
Other responses were “infarto” (n = 114, infarction),
“paralisia” (n = 13, paralysis), “ataque cardíaco” (n = 6,
heart attack), “convulsão” (n = 6, seizures), and in lower
frequency tumor or cancer, “fraqueza” (weakness), Parkinson’s or Alzheimer’s disease, “passamento” (malaise),
“depressão” (depression), “esclerose” (sclerosis), and
“some disease/sickness”. In Fig. 1 we show the relations
among some answers to this inquiry.
In Table 2 we show the substantial sociodemographic
and regional/geographic differences among the three
most cited names for stroke (“AVC”, “derrame” and
“trombose”) and “infarto”.
From those individuals who identified properly the
stroke (given any correct name to it), a higher proportion opted for calling EMS (530, 43.4%) than taking
the patient directly to a hospital (487, 39.9%, RR = 1.10,
95%CI = 1.05–1.16, p < .001). However, the intended
responses to the stroke were similar in each of the name
groups (Table 2).
Likewise, in Table 3 we depict the symptoms that volunteers spontaneously cited as being related to a stroke.
The most frequently reported symptom – impaired

Table 1 Sample characteristics and comparison with Brazil’s Northeast data
Variable
Age**
18–39#
40+
School years**
0–11#
12+
Sex, female#
Race, White#
Have private health insurance#
From the capital of a state#
From Bahia state#

n = 1,220
32 (24–45)
926 (75.9)
549 (24.1)
12 (11–16)
585 (39.7)
890 (60.3)
660 (54.1)
397 (32.5)
428 (35.1)
747 (61.2)
248 (20.3)

*census data from Instituto Brasileiro de Geografia e Estatistica (IBGE), 2019 (available at https://sidra.ibge.gov.br/)
**median (IQR), #n (%), - = not available data

Northeast (%)*
34.3
39.4
60.7
39.7
51.9
24.7
-

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Fig. 1 Venn’s diagram showing the relations among the answers to the question “what do you think is happening?”. Some volunteers answered more
than one name to our inquiry

Table 2 Bivariate analysis of sociodemographic, geographic and intended response, according to the words used to identify the
clinical presentation of stroke
Variable
Age, median (IQR)
School years, median (IQR)
Sex, female#
Race, White#
Health insurance#
Capital of a state#
Bahia state#
Reaction, call EMS#
Reaction, take directly to a hospital#
#

AVC (n = 841)
31 (23–44)***
12 (11–16)***
491 (58.4)***
285 (33.9)
332 (39.5)***
546 (64.9)***
141 (16.8)***
378 (44.9)
328 (39.0)

Derrame (n = 390)
33 (24–44)
12 (9–14)***
179 (45.9)***
108 (27.7)*
104 (26.7)***
218 (55.9)*
115 (29.5)***
156 (40.0)
167 (42.8)

Infarto (n = 114)
35 (26–49)*
12 (11–16)
62 (54.4)
30 (26.3)
31 (27.2)
65 (57.0)
35 (30.7)*
48 (42.1)
44 (38.6)

Trombose (n = 39)
38 (30–55)*
12 (9–16)
16 (41.0)
14 (35.9)
8 (20.5)*
11 (28.2)***
0 (0.0)***
14 (35.9)
16 (41.0)

n (%)

*p < .05, ***p < .001, indicates analysis of the specific column vs. all other answers

consciousness – was mentioned by only 129/1,220
(10.6%). “AVC”, “derrame” and “trombose” had a similar
profile of accompanying symptoms, such as headache,
paresthesia and impaired consciousness. However, the
word “infarto” was significantly more associated with cardiac symptoms, in tandem with few reports of headache

and impaired consciousness, which lead us to think that
“infarto” is not a word for stroke.
“AVC” group was younger, had higher years of education, economic status (inferred by private health insurance) and frequency of women; those individuals more
often lived in capitals.

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Table 3 Bivariate analysis of spontaneously-evoked related symptoms, according to the words used to identify the typical stroke
clinical case
Other symptoms
Impaired consciousness or cognition
Headache
Dysesthesia or paresthesia
Cardiac-related
Dizziness or incoordination or imbalance
Visual problems
Seizures
Dysautonomia

Correct answer (n = 1,220)
129 (10.6)
108 (8.9)
94 (7.7)
79 (6.5)
64 (5.2)
33 (2.7)
29 (2.4)
29 (2.4)

AVC (n = 841)
91 (10.8)
85 (10.1)*
75 (8.9)*
49 (5.8)
49 (5.8)
23 (2.7)
22 (2.6)
22 (2.6)

Derrame (n = 390)
36 (9.2)
24 (6.2)*
19 (4.9)*
27 (6.9)
14 (3.6)
11 (2.8)
9 (2.3)
7 (1.8)

Infarto (n = 114)
6 (5.3)*
5 (4.4)*
14 (12.3)
30 (26.3)***
8 (7.0)
2 (1.8)
4 (3.5)
5 (4.4)

Trombose (n = 39)
3 (7.7)
1 (2.6)
2 (5.1)
3 (7.7)
2 (5.1)
0 (0.0)
1 (2.6)
1 (2.6)

Other symptoms mean symptoms not presented in the presented clinical case
Correct answer column describes characteristics of all correct answers (AVC, derrame, trombose and aneurisma) as a whole
*p < .05, ***p < .001, indicates analysis of the specific column vs. all other correct answers, as a reference group

“Derrame” was quoted often in Bahia and in non-capitals. This group was made mostly of non-Whites, men,
with lower levels of education and economic status. The
accompanying symptoms cited were in general similar in
the “AVC” and “derrame” groups.
“Trombose” was cited mainly in the states of Paraíba
(n = 17), Ceará (n = 11), but also Maranhão, Piauí and Rio
Grande do Norte in lesser frequency. Other states did not
mention this name. Individuals in this group were significantly older, lived away from capitals and had no health
insurance. There was no difference concerning related
symptoms.
The group that responded “infarto” had a higher chance
of stating that cardiac symptoms were related to the case
(RR = 1.35, 95%CI = 1.18–1.54, p < .001), in tandem with
significantly less headache and impaired consciousness.
They were older and lived in Bahia more often.

Discussion
As far as we know, this is the largest Brazilian study
assessing the knowledge of the general population
about stroke, and the first exploring the different words
to name a stroke. Considering that there was no difference in the intended reaction and a similar profile of
satisfactory spontaneously-evoked related symptoms,
we consider that “AVC”, “derrame” and “trombose” are
equivalent words used to describe a stroke in this population. It is worth noting that there are significant influences of geographic/regional, sociodemographic and
probably cultural differences in the use of these names,
then populational campaigns about stroke should apply
them in order to reach a wider audience. Another word
to describe the situation we presented, “infarto”, seems
to be a misconception of the clinical case and is related
to myocardial infarction. The awareness of other stroke
warning signs was found to be inadequate, emphasizing
the necessity for additional studies and targeted campaigns to address this issue..

There are 17 MeSH terms for stroke in Portuguese [14],
but they could be summarized in 3 sets: “AVC”, “ictus”
and “apoplexia”. “Trombose” is not listed and “derrame”
is only listed under the heading “hemorrhagic stroke”.
The first word in the History of Medicine describing a
stroke, apoplexy [9], is not anymore used in this sense – it
was a generic term referring to a sort of diseases which
have in common a sudden onset (such as pulmonary
embolism and myocardial infarction). A review among
Spanish-speaking populations found that there were at
least 8 words to stroke [7], including “trombosis”, “infarto
cerebral”, “derrame cerebral” and “embolia”. Those observations highlight the notion that languages are alive and
evolving (considering the Latin origin of Portuguese and
Spanish, likewise similarities with English words), and
that pathophysiological mechanisms – like embolism,
aneurysm, thrombosis, and spilling (“derrame”) of blood
– may influence disease naming.
Some Brazilian studies recognized “derrame” [8, 10, 12,
13, 15] as a common alternative name for stroke. Indeed
it is widely used in lay media [14]. This was cited mostly
by non-White, less-educated men who also lived away
from capitals, and without health insurance. Also, “derrame” was often used in Bahia state.
Nevertheless, only one study identified “trombose” [8],
cited by 9.9% of their respondents; of note, that study
also collected data in the Northeast, notably in the Ceará
state. We collected data in three cities of Bahia state, but
no one named “trombose” there. We also found particular geographical and socio-economical characteristics in
this group.
Those educational, economical, racial, geographical
and probably cultural differences among the names identified point out various aspects shaping the populational
experience and the words for stroke. We highlight that
these informal words for stroke in Brazil (“derrame” and
“trombose”) were cited mostly by “minorities” (Blacks,
poor ones, and undereducated), who are at higher risk for
stroke [16] and might not be reached in campaigns that

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do not apply those terms. Thus, campaign developers
should be aware of these alternative terms and use them,
in order to maximize the target population and guide
enhancing previous knowledge more than providing
new information. Besides, EMS workers and physicians
should keep in mind the possibility of stroke even in calls
for other reasons. It is possible that there are other words
for stroke that we did not identify.
Interestingly, the study of Pontes-Neto et al. [8] considered that “infarto” was a synonym for stroke, whereas
other authors [10] and us believe that “infarto” is a misinterpretation of myocardial infarction and not a stroke
recognition. Our approach of spontaneously-evoking
related symptoms revealed more cardiac, besides less
stroke-associated symptoms in the group that described
the clinical scenario as “infarto”. However, as shown in
Fig. 1, some individuals answered “infarto” and “AVC”,
“derrame” or “aneurisma”, indicating a confusion about
these disorders amongst the general population. Of note,
one Brazilian study found that 30% of volunteers stated
the heart was the organ affected in a stroke [17]. Furthermore, we found no difference in the intended reaction
concerning all these words, indicating a notion of similar
disease severity.
Knowledge about other symptoms related to stroke
was poor, however similar to another study that applied
a strategy similar [10] to ours (the main cited symptoms
were headache and cognition problems, both by 8.1% of
their sample). In general, the most common signs and
symptoms cited in Brazilian studies applying an openended approach [12, 13, 17, 18] are motor (facial drop
and/or hemiplegia), language impairment, headache and
paresthesia, with a frequency around 30 − 20%. This frequency was similar in developed countries [7, 19, 20].
Recall of symptoms related to posterior circulation is
even poorer.
In Brazil, the SAMU acronym is the equivalent of the
FAST (face, arm, speech, time) algorithm, which has
been applied in stroke educational campaigns, focusing
on those symptoms. Recently, considering that symptoms of posterior circulation were underrepresented
in those campaigns, the acronym evolved to BE-FAST
(adding balance and vision-related symptoms), which
improved stroke accuracy by 10% [21]. To the best of
our knowledge, this addition was not yet applied in Portuguese-speaking populations for campaign purposes.
Considering that balance and eye alterations were cited
by only 5% and 3% of our sample, respectively, it is important to add these symptoms to stroke campaigns and
train emergency physicians to enhance stroke recognition scenarios. Furthermore, how to recognize and react
to a stroke should be integrated into the school curriculum [22]. However, recognition of stroke warning signs
might not be related to early arrival in stroke centers [23].

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Future research should investigate the impact of adding
“alternative”, non-technical, words in stroke campaigns
regarding the outcomes of patients, including in other
countries. Likewise, implement regional versions of BEFAST and assess the levels of retention of this more complex screening tool.
Our study has a number of limitations. Firstly, our
sample is young and highly educated, which may not represent the Brazilian population. Second, we cannot rule
out that there are other words that accurately describe
a stroke in Brazil. “Trombose” and “aneurisma” were
underrepresented in our sample and it is possible that
small differences in these name groups would be found
in larger samples, concerning sociodemographic, geographic, and clinical aspects.

Conclusion
There are at least three words for stroke in Portuguese
(“AVC”, “derrame” and “trombose”); they have a similar
profile of spontaneously-evoked associated symptoms
and correct intended responses. However, knowledge
about associated symptoms (especially those related to
posterior circulation) was poor and this issue should be
addressed in populational campaigns. Physicians and
EMS workers should keep in mind that stroke may be
referred to as other names. Other countries should look
for other words that lay population use to describe a
stroke.
Our data highlight the need for assessing the benefits
of the BE-FAST algorithm in our population.
Acknowledgements
Authors thank all medical students who acquired data for this study, namely
Caline de Almeida Barbosa, Giuliana Maria Morais Gonzalez, Neila Clediane de
Sousa Menezes, Rasec Kayan Oliveira Santos, Roberto Carlos de Sousa Alves
Junior, Rômulo Martins Ferreira Santos, and Yuri de Almeida Oliveira.
Author contributions
MLM: conceived and designed the study, performed the statistical analysis,
interpreted the results and reviewed critically and scientifically the manuscript.
AGC, MFA, LMD, LPF, WMG and MVS acquired data as interviewers and wrote
the first manuscript draft. All authors have read and approved the submitted
manuscript. All authors are responsible for the paper scientific integrity.
Funding
This study did not receive any grants or funding.
Data Availability
Data collected for the study, which were presented in this publication,
including de-identified individual participant data can be made available to
other researchers from the corresponding author on reasonable request and
after signing appropriate data sharing agreements and providing approval
from respective ethics boards. A data dictionary defining each field in the set
also can be provided.

Declarations
Ethics approval and consent to participate
Ethical approval for this study was obtained from the Universidade Católica de
Pernambuco Ethics Committee (approval number: 4.299.487). We confirm that

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all methods were carried out in accordance with the Brazilian Ethics standards
and the Declaration of Helsinki.
All participants gave their informed consent prior to enroll the survey.

11.

Consent for publication
Not applicable.

12.

Competing interests
All the authors declare that they have no conflict of interests to declare.
13.
Received: 1 February 2023 / Accepted: 10 July 2023
14.
15.
References
1. Puolakka T, Strbian D, Harve H, Kuisma M, Lindsberg PJ. Prehospital Phase of
the Stroke Chain of Survival: a prospective observational study. J Am Heart
Assoc. 2016;5(5). https://doi.org/10.1161/JAHA.115.002808.
2. Worthmann H, Schwartz A, Heidenreich F, et al. Educational Campaign on
Stroke in an Urban Population in Northern Germany: influence on Public
Stroke awareness and knowledge. Int J Stroke. 2013;8(5):286–92. https://doi.
org/10.1111/j.1747-4949.2012.00809.x.
3. Bray JE, Martin J, Cooper G, Barger B, Bernard S, Bladin C. Paramedic
identification of stroke: community validation of the Melbourne Ambulance Stroke screen. Cerebrovasc Dis. 2005;20(1):28–33. https://doi.
org/10.1159/000086201.
4. Jones SP, Bray JE, Gibson JM, et al. Characteristics of patients who had a
stroke not initially identified during emergency prehospital assessment: a
systematic review. Emerg Med J. 2021;38(5):387–93. https://doi.org/10.1136/
emermed-2020-209607.
5. Calderaro M, Salles IC, Gouvêa GB, et al. The lack of knowledge on acute
stroke in Brazil: a cross-sectional study with children, adolescents, and adults
from public schools. Clinics. 2022;77:100052. https://doi.org/10.1016/j.
clinsp.2022.100052.
6. de Mélo Silva Júnior ML, Menezes NC, de Vilanova S. Recognition, reaction,
risk factors and adequate knowledge of stroke: a brazilian populational
survey. J Stroke Cerebrovasc Dis. 2023;32(8):107228. https://doi.org/10.1016/j.
jstrokecerebrovasdis.2023.107228.
7. Hawkes MA, Ameriso SF, Willey JZ. Stroke knowledge in spanish-speaking populations. Neuroepidemiology. 2015;44(3):121–9. https://doi.
org/10.1159/000381100.
8. Pontes-Neto OM, Silva GS, Feitosa MR, et al. Stroke awareness in Brazil. Stroke.
2008;39(2):292–6. https://doi.org/10.1161/STROKEAHA.107.493908.
9. Engelhardt E. Apoplexy, cerebrovascular disease, and stroke: historical evolution of terms and definitions. Dement Neuropsychol. 2017;11(4):449–53.
https://doi.org/10.1590/1980-57642016dn11-040016.
10. Meira F, Magalhães D, da Silva LS, Mendonça e Silva AC, Silva GS. Knowledge
about Stroke in Belo Horizonte, Brazil: A Community-Based study using an

16.

17.
18.
19.

20.
21.
22.
23.

innovative Video Approach. Cerebrovasc Dis Extra. 2018;8(2):60–9. https://doi.
org/10.1159/000488400.
Dossi DE, Hawkes MA, Pujol-Lereis VA, et al. A Population-Based survey of
Stroke Knowledge in Argentina: the SIFHON Study. Neuroepidemiology.
2019;53(1–2):32–40. https://doi.org/10.1159/000497413.
Marques MT, Guachala MC, Schoeps VA, Simis M, Ribeiro MCS, de Gagliardi
A. Popular knowledge of stroke in São Paulo: a cross-sectional study within
the World stroke campaign. Sao Paulo Med J. 2021;139(2):117–22. https://doi.
org/10.1590/1516-3180.2020.0116.r1.18112020.
Gomes ABAGR, Henrique M, Schoeps VA, et al. Popular stroke knowledge
in Brazil: a multicenter survey during “World Stroke Day. eNeurologicalSci.
2017;6:63–7. https://doi.org/10.1016/j.ensci.2016.12.002.
Gagliardi RJ. Acidente Vascular cerebral ou Acidente Vascular Encefálico? Rev
Neurociências. 2001;18(2):131–2. https://doi.org/10.4181/RNC.2010.1802.02p.
Falavigna A, Teles AR, Vedana VM, et al. Awareness of stroke risk factors and
warning signs in southern Brazil. Arq Neuropsiquiatr. 2009;67(4):1076–81.
https://doi.org/10.1590/S0004-282X2009000600022.
McGruder HF, Malarcher AM, Antoine TL, Greenlund KJ, Croft JB. Racial
and ethnic disparities in Cardiovascular Risk factors among stroke
survivors. Stroke. 2004;35(7):1557–61. https://doi.org/10.1161/01.
STR.0000130427.84114.50.
Pitton Rissardo J, Fornari Caprara AL, Cervi Prado AL. Stroke literacy in a
south brazilian city: A Community Based Survey. J Stroke Cerebrovasc Dis.
2018;27(9):2513–8. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.05.006.
Campos-Sousa RN, Soares VYR, Almeida KJS, et al. Knowledge of stroke
among a brazilian urban population. Arq Neuropsiquiatr. 2007;65(3a):587–91.
https://doi.org/10.1590/S0004-282X2007000400007.
Ramírez-Moreno JM, Alonso-González R, Peral-Pacheco D, MillánNúñez MV, Aguirre-Sánchez JJ. Stroke awareness is worse among
the Old and poorly educated: a Population-Based survey. J Stroke
Cerebrovasc Dis. 2015;24(5):1038–46. https://doi.org/10.1016/j.
jstrokecerebrovasdis.2014.12.031.
Neau J-P, Ingrand P, Godeneche G. Awareness within the french population
concerning stroke signs, symptoms, and risk factors. Clin Neurol Neurosurg.
2009;111(8):659–64. https://doi.org/10.1016/j.clineuro.2009.05.015.
Chen X, Zhao X, Xu F, et al. A systematic review and Meta-analysis comparing
FAST and BEFAST in Acute Stroke Patients. Front Neurol. 2022;12. https://doi.
org/10.3389/fneur.2021.765069.
Arboix Damunt A, Arboix Alió A, Hernández Arrieta M. Escaso conocimiento
de la enfermedad vascular cerebral en una muestra de jóvenes adolescentes.
Rev Neurol. 2003;37(05):500. https://doi.org/10.33588/rn.3705.2003258.
Panício MI, Mateus L, Ricarte IF, et al. The influence of patient’s knowledge about stroke in Brazil: a cross sectional study. Arq Neuropsiquiatr.
2014;72(12):938–41. https://doi.org/10.1590/0004-282X20140167.

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