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100 000 people in the UK have a stroke and worldwide it is responsible for 15 million deaths every year. With the ageing population, it is predicted that mortality will rise by 45% over the next 20 years in Europe and there will be over 4.5 million stroke survivors. Only 30 years ago it was considered to be a largely untreatable disease. There was no evidence for any acute intervention and rehabilitation was sporadic and rarely available at all in the community. In fact, little had changed over the previous century since Osler had written that ‘there was no possibility of a cure’. Huge advances have been made in reducing the severity of stroke. Being managed on a stroke unit compared to a general ward reduces the odds ratio of death or dependency by 21%. Intravenous thrombolysis does not save lives but overall greatly increases the chance of disability free survival. The last 3 years has seen publication of multiple trials …