Stroke is the third most common cause of death worldwide. About 80% of strokes are ischaemic. The only reliable way of distinguishing cerebral infarction from haemorrhage is with neuroimaging, most commonly CT scanning in the UK. The last decade has produced a number of RCTs clarifying former areas of management uncertainty. Three interventions have been shown to be beneficial in acute stroke: admission to a stroke unit; early aspirin; and intravenous thrombolysis. Aspirin and stroke service admission should be available to all patients, thrombolysis is of benefit to a select minority of patients. Accurate diagnosis, investigation, and management of physiological variables such as BP, temperature, glycaemia, and oxygen saturation should improve outcome. Multiprofessional guidelines exist and, when used with education, audit, and other areas of clinical governance, improve the basic standards of care. The National Sentinel Audits of Stroke have repeatedly shown that care is suboptimal. Secondary prevention with anti-platelet drugs (or warfarin in the case of atrial fibrillation), statins, and antihypertensive drugs, reduce recurrent strokes and other vascular events. Patients with 70–99% stenosis of the ipsilateral carotid bulb or internal carotid artery may benefit from early carotid endarterectomy.
