We designed this study to determine factors associated with community stroke knowledge that could be used to improve education strategies. A survey was mailed to random adult residents of Olmsted County, Minnesota. The questions assessed knowledge of stroke (definition, treatment, symptoms, and risk factors) and access to and attitudes toward health care. Background information was obtained from medical records for responders and non-responders. Chi square and multivariate logistic regression analyses were used to identify predictors of stroke. Three hundred and sixty four (36%) of 1086 written surveys were returned. The mean age of respondents was 51.6 years. "Stroke" was incorrectly defined by 40% of respondents. Only 67% of respondents correctly identified stroke risk factors. Paralysis was commonly recognized as a symptom of stroke; only 42% of persons, however, would first call 911 if having a stroke. The thrombolytic treatment window was not known by 32%. Participants concerned about health care cost and access were less likely to correctly answer questions about symptoms or treatment. People with stroke risk factors or a personal or family history of stroke or transient ischemic attack were no more knowledgeable about stroke than those without. We concluded that knowledge of stroke is poor, even among persons with a previous stroke or risk factors for stroke. There is a lack of awareness that acute ischemic stroke therapy exists and that it must be used in an urgent fashion. Structured education programs for stroke awareness must be multi-faceted, targeting those persons at high risk while at the same time accounting for health care cost concerns, confidence in the medical community, and the needs of the elderly.