—We appreciate Dr Alberts' concerns about the potential shortcomings in determining the time of stroke onset. This is clearly an inherent problem in all clinical studies and trials that depend on a patient's or family's recollection and ability to accurately communicate a history. In our study, considerable time and effort were devoted to circumvent this problem at the level of data collection and in our subsequent analysis. Time of stroke onset was determined from the patient and/or the family at the time of initial evaluation by the study neurologist (within 24 hours of stroke onset). In addition, they were asked specifically if symptoms had first been noted on awakening. In the data analysis, patients who had noted stroke on awakening and those whose time of stroke onset had been estimated to occur at the time of awakening were included in the category of "stroke on awakening." Twenty-nine patients
Marsh EE, Biller J, Adams HP. Circadian Variation in Stroke-Reply. Arch Neurol. 1991;48(8):790. doi:10.1001/archneur.1991.00530200026012
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