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Background and Purpose-Stroke is the leading cause of death in Brazil. This community-based study assessed lay knowledge about stroke recognition and treatment and risk factors for cerebrovascular diseases and activation of emergency medical services in Brazil. Methods-The study was conducted between July 2004 and December 2005. Subjects were selected from the urban population in transit about public places of 4 major Brazilian cities: São Paulo, Salvador, Fortaleza, and Ribeirão Preto. Trained medical students, residents, and neurologists interviewed subjects using a structured, open-ended questionnaire in Portuguese based on a case presentation of a typical patient with acute stroke at home. Results-Eight hundred fourteen subjects were interviewed during the study period (53.9% women; mean age, 39.2 years; age range, 18 to 80 years). There were 28 different Portuguese terms to name stroke. Twenty-two percent did not recognize any warning signs of stroke. Only 34.6% of subjects answered the correct nationwide emergency telephone number in Brazil (#192). Only 51.4% of subjects would call emergency medical services for a relative with symptoms of stroke. In a multivariate analysis, individuals with higher education called emergency medical services (Pϭ0.038, ORϭ1.5, 95%, CI: 1.02 to 2.2) and knew at least one risk factor for stroke (PϽ0.05, ORϭ2.0, 95% CI: 1.2 to 3.2) more often than those with lower education. Conclusions-Our study discloses alarming lack of knowledge about activation of emergency medical services and availability of acute stroke treatment in Brazil. These findings have implications for public health initiatives in the treatment of stroke and other cardiovascular emergencies. (Stroke. 2008;39:292-296.)

Background and Purpose— Diagnostic delay of cerebral vein and dural sinus thrombosis may have an impact on outcome. Methods— In the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) cohort (624 patients with cerebral vein and dural sinus thrombosis), we analyzed the predictors and the impact on outcome of diagnostic delay. Primary outcome was a modified Rankin Scale score >2 at the end of follow-up. Secondary outcomes were modified Rankin Scale score 0 to 1 at the end of follow-up, death, and visual deficits (visual acuity or visual field). Results— Median delay was 7 days (interquartile range, 3 to 16). Patients with disturbance of consciousness ( P <0.001) and of mental status ( P =0.042), seizure (<0.001), and with parenchymal lesions on admission CT/MR ( P <0.001) were diagnosed earlier, whereas men ( P =0.01) and those with isolated intracranial hypertension syndrome ( P =0.04) were diagnosed later. Between patients diagnosed earlier and later than the median delay, no statistically significant differences were found in the primary ( P =0.33) and in secondary outcomes: modified Rankin Scale score 0 to 1 ( P =0.86) or deaths ( P =0.53). Persistent visual deficits were more frequent in patients diagnosed later ( P =0.05). In patients with isolated intracranial hypertension syndrome, modified Rankin Scale score >2 at the end of follow-up was more frequent in patients diagnosed later ( P =0.02). Conclusions— Diagnostic delay was considerable in this cohort and was associated with an increased risk of visual deficit. In patients with isolated intracranial hypertension syndrome, diagnostic delay was also associated with death or dependency.