This manuscript brings a new scale that can help the precocious diagnosis of stroke and minimize the misdiagnosis that are common at emergency department. Besides that, it can help to uniformize the attendance to those patients with suspects of stroke or some cerebrovascular disease.

The abstract is clear and objective. It brigs the entire information of the article on a simple way and easy to understand. The reader can have an consistent overview of the research only reading the abstract. The title brigs a direct point of what is coming along de reading of the article. And the references are well cited and the majority are up t the five past years.

The manuscript it is clear what is already known about this topic and the research question is clearly outlined. In addition, the research question is justified given what is already known about the topic. In this way, the manuscript brings a view of how to approach acute stroke and a scale that have high values of sensitivity, speciality, and predictive positive and negative values.

It is a review manuscript, seen this the methodology is good done by good keywords in reliable data bases. It shows how the researches did and validated the scale, so that others researches could apply this in others countries.

This manuscript shows that the recognition of acute stroke on the emergency room it is difficult to do, how it shows by Tarniutzer et al, 2017, that demonstrated a rate of 10% of misdiagnosis at the recognition of acute stroke in the emergency room when there is common symptomatology presentation. Besides that, when the symptomatology are uncommon, the rate of misdiagnosis increases to 20%. This shows that the recognition of acute stroke in emergency room is not so good. Seen this, Nor et al., 2005, developed a new scale to be used at the emergency room, what demonstrate a new way to diagnosis acute stroke, according Rudd et al., 2015, due the inexistence of scales that diagnosis stroke in the emergency room. Seen the high rate of misdiagnosis and the inexistence os scales in the emergency room, Nor et al., 2005, after applying the scale to 343 suspected cases of stroke, brings a rate of 93% of sensitivity, 83% of specificity, 90% of predictive positive value and 88% of predictive negative value.

The results discussed from multiple angles and placed into context without being overinterpreted. The conclusions answer the aims of the study.The conclusions supported by references or results. The limitations of the study fatal or are they opportunities to inform future research. In this way, the manuscript shows that there is ways to approach acute strokes with excellency and with minimum of misdiagnosis.