The global burden of stroke is huge—about 5 million people a
year die of cerebrovascular disease. Because stroke is often not
fatal, the “hidden burden” is even greater. A third of patients
who survive a stroke are dependent on others after 1 year and a
third of stroke survivors will have a recurrence. What can we do
to reduce the number of deaths, recurrence, and the global
burden of this disease? Treatment options for stroke are
limited. Alteplase, a thrombolytic drug, is approved for the
treatment of ischaemic stroke in the USA, Canada, and Germany
and was recently approved by the European Agency for the
Evaluation of Medicinal Products (see page 207). However,
thrombolysis can only be used for non-haemorrhagic stroke and is
only effective if given within a narrow time window (3 h after
symptom onset). The number of patients eligible for thrombolytic
treatment is therefore dependent on quick recognition of
symptoms, immediate referral to a stroke specialist, and swift
diagnosis and assessment of potential