Cerebrocentric bias in stroke terminology and the hemovascular paradigm: a conceptual reframing of cerebrovascular disease classification.

Stroke remains one of the clinical conditions with the highest global disease burden, yet whose underlying risk factors and pathogenetic mechanisms are increasingly well understood. Nevertheless, the prevailing terminology for stroke-particularly the terms "cerebrovascular" and the broader "cardiovascular"-semantically foregrounds the target-organ manifestation of the disease rather than its etiological center. This article aims to reassess the alignment of stroke terminology with the pathogenetic hierarchy and to analyze the conceptual limitations of organ-centered naming. At the intersection of psycholinguistics, cognitive framing theory, translational stroke research, pan-vascular medicine, and multi-organ disease models, the article proposes the concept of "cerebrocentric bias." According to this model, the semantic dominance of the organ component in the term "cerebrovascular" may shift clinical reasoning and research priorities from the etiological root toward the phenotypic outcome. The analysis reveals a two-tiered problem with organ-centered terminology: at the macro level, the term "cardiovascular" places the heart at the semantic center, casting stroke into the shadow within the broader spectrum; at the micro level, the term "cerebrovascular" foregrounds the brain, pushing blood composition changes, systemic arterial pathology, and hemodynamic mediation to the background. On this basis, the article advances the hemovascular paradigm as an alternative conceptual framework. This paradigm explains the disease through a three-stage model: the primary stage-blood composition changes and systemic arterial pathology; the secondary stage-hemodynamic disturbances; and the tertiary stage-multi-organ clinical phenotypes. Under this approach, stroke is interpreted not as an isolated event but as the cerebral phenotype of the hemovascular spectrum. The authors regard this proposal not as one that invalidates existing clinical diagnoses but rather as an evolutionary recentering that unifies them etiologically.