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Stroke and transient ischaemic attacks.

accounts for about 5% ofNHS hospital costs. Stroke is the commonest cause of severe physical disability. About 100 000 people suffer a first stroke each year in England and Wales. It is important to emphasise that around 20-25% of all strokes affects people under 65 years of age. The annual incidence of stroke is two per 1000.' About 10% of all patients suffer a recurrent stroke within one year. The prevalence of stroke shows that there are 250 000 in England and Wales. Each year approximately 60 000 people are reported to die of stroke; this represents about 12% of all deaths. Only ischaemic heart disease and cancer account for more deaths. This means that in an "average" district health authority of 250 000 people, there will be 500 patients with first strokes, with a prevalence of about 1500. Transient ischaemic attacks (TIAs) are defined as acute, focal neurological symptoms, resulting from vascular disease, which resolve in less than 24 hours; most settle in less than 30 minutes. The incidence of TIAs is a quarter that of stroke. Over the past 20 years, mortality from stroke has fallen both in the United Kingdom and United States by about a quarter. There has also been a fall in the incidence of stroke.2 This is probably real but may be partly accounted for by the reclassification of stroke. The more successful treatment of hypertension is also likely to be relevant, but is unlikely to be a complete explanation as this improvement had also been seen during 1950-60, before the treatment of hypertension was widely practised. Stroke is not a diagnosis. It is merely a description of a symptom complex thought to have a vascular aetiology. It is important to classify stroke according to the anatomy of the lesion, its timing, aetiology, and pathogenesis. This will help to decide the most appropriate management.