The recently published NICE clinical guideline on diagnosis and initial management of stroke and transient ischaemic attack (TIA) is a landmark publication for all clinicians involved in stroke care in the UK.1 The guideline is important, since, along with the National Stroke Strategy2 and the recent NICE approval for alteplase for acute stroke,3 it sends another clear signal about the importance of stroke, the world’s most important cause of adult disability and third largest killer. This change in climate started in 2005, when the National Audit Office published a report drawing attention to the enormous cost of stroke to the community and the NHS.4 More people in the UK suffer stroke or TIA each year than myocardial infarction, yet stroke has for many years been badly neglected and underfunded in comparison with ischaemic heart disease. Moreover, the Audit Office estimated that the direct care cost to the NHS was £2.8 billion per year, more than the cost of treating coronary heart disease. The response of the government was to task the Department of Health to develop the National Stroke Strategy, published last year under the guidance of Professor Roger Boyle, National Director for both Heart Disease and Stroke.2 Heart Disease and Stroke commonly overlap, and both require an emergency response with a view to salvaging ischaemic tissue, so the link in the Department of Health was logical. However, the approach to acute stroke in UK has been inappropriately pedestrian compared with the approach to coronary ischaemia. Recent advances in our understanding and approach to acute stroke and TIA mandated a radical change in this approach. The NICE guideline provides much of the detail of what is required.

The guideline gives a comprehensive and considered summary of the available evidence on the diagnosis and early management …