Age limit up to 55 years allows exploring subgroups with increasing age including patients with risk factor and aetiology profiles selleck resembling those found in elderly patients with stroke.10 Therefore, the findings may be extrapolated to some extent to the stroke population in general. Nevertheless there are some limitations regarding this study: The main purpose of sifap1 was not to validate

a stroke recognition instrument. Therefore, ‘FAST wording’ was primarily not covered with a specific item in the CRF. Instead we asked for paresis directly after CVE and employed the NIH Stroke Scale immediately after hospital admission (median delay: one day). Assessments ruling out stroke mimics (ie, blood glucose level) influence specificity but cannot be used for public education.6 Since we excluded stroke mimics by definition, our study is not designed to calculate for positive and negative predictive values of distinct stroke signs. Moreover, there is a problem in general to calculate for false-negative

diagnoses, that is, undiagnosed strokes in a population under survey. It has to be noted also, that we did not consider haemorrhage, subarachnoid haemorrhage or venous thrombosis in our calculations. Addressing all these strokes types may further add to complexity and dilute the awareness message. The FAST scheme was develop to screen for potential stroke victims in a preclinical setting.9 In contrast our patients were included after admission to a neurological department. This needs to be taken into account when interpreting our results. Extensive MRI documentation allowed us to validate the clinical stroke diagnosis and constituted a robust additional aspect in identifying presenting symptoms in acute young patients with stroke. One-third of vertebra-basilar strokes and transient attacks could not be visualised on MRI. In these cases the appraisal of an experienced neurologist was decisive. Notably, there was no relevant difference regarding signs included

in the FAST scheme comparing patients with and without proven MRI lesions. Implications for public campaigns Instruments that help the lay public to identify stroke in prehospital setting are elementary to trigger early treatment. Our study in patients Dacomitinib with stroke (aged 18–55 years) proves that symptoms considered in the FAST scheme may be useful for identifying young patients with stroke. Especially young patients with stroke eligible for thrombolysis might be targeted by a FAST evaluation. In contrast, clustering only clinical symptoms according to FAST, it might be less effective in young patients with stroke with TIA and infarcts in the posterior circulation. Since risk factors and aetiology profiles in the sifap1 cohort resembled those found in elderly patients with stroke,10 conclusions from our study may be also valid in older age groups.