PONE-D-21-20627

Prevalence of the Frank’s sign by aetiopathogenic stroke subtype: a prospective analysis.

PLOS ONE

Dear Dr. Serena,

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PLOS ONE

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Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: It was an honour to review your manuscript. Unfortunately, it requires many corrections, including major changes in data analysis and interpretation. All my comments and explanations were provided in the attached file "Comments".

Reviewer #2: Dear Dr Joaquin Serena:

Thank you for allowing us to read your interesting manuscript. This is a cross-sectional descriptive study that analyzed the prevalence of the Frank’s sign in patients suffering from acute stroke with focus on its prevalence in each aetiopathogenic stroke subtypes. This study concluded that Frank's sign was significantly associated with age, particularly in patients older than 70 with vascular risk factors and that is prevalent in all aetiopathogenic ischemic stroke subtypes, including ESUS. It is a great effort, congratulations. Please consider the following comments.

1.- It should be important to mention in the discussion whether the presence of the unilateral or bilateral Frank's Sign has the same clinical translation according to previous reports, since in the current study both were taken without distinction

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2.- In the paragraph: As previously described, we found a strong and significant association between the presence of ELC and age, with ELC being particularly prevalent in patients who were older than 70 years (74.7%). Does the term “as previously” mean in previous studies? Because it is the first time that this idea was mentioned in the results of the body of the text.

3.- In the paragraph: On analysing carotid ultrasonographic markers of vascular atherosclerosis, we found a significant relationship between the prevalence of ELC and the presence of atherosclerotic plaques (63.6% vs. 45.2%, p<0.05). Are you referring to non-stenotic plaques? It should be important to clarify.

4.- In the limitations of the study, it should be important to included that the assessment of Frank's sign was carried out through photographs.

5.- It should be important to improve the quality of the tables, especially Table 2, which has disordered information ("Internal carotid artery stenosis")

6.- I think that the conclusion could be improved if the relevance of investigating atherosclerosis in patients with ESUS and Frank's sign is pointed out.

Thanks,

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Reviewer #1: No

Reviewer #2: Yes: Vanessa Cano-Nigenda

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Attachments

Attachment

Submitted filename: Comments.docx

Prevalence of the Frank’s sign by aetiopathogenic stroke subtype: a prospective analysis.

PONE-D-21-20627R1

Dear Dr. Serena,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Juan Manuel Marquez-Romero, M.D., M.Sc.

Academic Editor

PLOS ONE