Definitions, epidemiology and impact

The word ‘stroke’ is used to refer to a clinical syndrome, of presumed vascular origin, typified by rapidly developing signs of focal or global disturbance of cerebral functions lasting more than 24 hours or leading to death (World Health Organization, 1978). It affects between 174 and 216 people per 100 000 population in the UK each year, and accounts for 11% of all deaths in England and Wales (Intercollegiate Stroke Working Party, ISWP, 2004). Of the 100 000 people having a first stroke each year in England and Wales half are over 75 years, 10 000 are under retirement age and about 250 are children (UK Division of Clinical Psychology, DCP, 2002). Ischaemic cerebral infarction accounts for 69% of strokes, primary intracerebral haemorrhage 13%, subarachnoid haemorrhage 6% and 12% are of uncertain type (ISWP, 2004).

Stroke has a major impact on people's lives. It is the leading cause of severe disability in older adults and the third most common cause of death in the UK and other developed countries. Within 1 month of stroke 30% die, 35% are still significantly disabled after 1 year and 5% need long-term residential care (Department of Health, 2001). A substantial proportion of health and social care resources are devoted to the immediate and continuing care of people who have had a stroke including 20% of acute hospital beds, 25% of longer term beds and 4% of UK National Health Service expenditure (Department of Health, 2001).