The principles of management of patients with a suspected acute stroke are to:

• make an accurate diagnosis of stroke, its pathological type (i.e. infarct or haemorrhage) and aetiological subtype (cause of the infarct of haemorrhage);

• accurately assess the patient's impairments, disabilities and handicaps, and compare with previous impairments, disabilities and handicaps;

• estimate the prognosis for survival, recurrent stroke, other serious vascular events and future handicap;

• discuss the prognosis with the patient and family (if possible), and set shared, common short- and long-term goals;

• consider which services are required to meet the shared common goals and how to access and deliver them;

• optimise survival free of handicap by immediate brain reperfusion strategies in appropriate patients with ischaemic stroke, optimise physiological homoeostasis, anticipate and prevent complications of stroke, prevent recurrence of stroke and other major vascular events, begin rehabilitation immediately, and continue longer-term rehabilitation and support.

The management of stroke patients (and their carers and families) requires an integrated, comprehensive and coordinated stroke service which meets the needs (and wishes) of patients and carers in an effective, efficient and equitable manner.

The major components of an organised stroke service are as follows:

1. A fast-track outpatient clinic: To provide rapid assessment, diagnosis and secondary prevention measures for patients with suspected transient ischaemic attack (TIA) and non-disabling stroke.

2. A comprehensive stroke unit: To provide rapid assessment, diagnosis and inte rvention by a specialist multidisciplinary team.

3. Early supported discharge: To facilitate earlier discharge from hospital with enhanced support and rehabilitation input in the home setting.

4. Longer-term support and rehabilitation: To review continued progress, and new and ongoing needs, and maintain rehabilitation and support (Langhorne, 2002).