North Carolina lies in the country's Stroke Belt, which is a region where cerebrovascular disease is a major public health problem. We performed an open survey of patients residing in a Stroke Belt community who had access to medical care to determine their level of knowledge about stroke risk factors, symptoms, and emergency procedures. Between June and December 1997, a random sample of patients, over age 55, at 13 primary care medical practices in central North Carolina were asked to complete an open questionnaire. Responses were obtained from 202 patients (78% Caucasian, 18% African American, 4% other or unstated). Overall, 80% of those who responded believed that stroke could be, prevented, and 95% felt that stroke could be treated. Although only 12% could not correctly name any stroke risk factors, 53% could not list any of the symptoms of a transient ischemic attack (TIA), and 25% could not provide any stroke, symptoms. Multiple regression analyses showed that knowledge of stroke risk factors was independently related to both age and race (multiple r=.29, P<.0004; P<.01, for age and P<.01 for race) and that knowledge of stroke symptoms was independently related to age with a trend towards an effect of race (multiple r=.18, P<.04; P=.05 for age and P=.08 for race). This study shows that even for patients with access to medical care residing in a portion of the country with a particularly high incidence of cerebrovascular disease, knowledge of stroke risk factors, TIA symptoms, and stroke symptoms remains relatively poor. Those at higher epidemiological risk for cerebrovascular disease were relatively less knowledgeable. Based on these data, the need for local public education, particularly within Stroke Belt communities, requires further emphasis.