Each year, about 150,000 people in the UK will have a stroke; 30,000 of these are recurrent strokes and 10,000 will occur in people under the age of 65 years. The result is an estimated economic burden to the NHS in direct health care costs of over £2.8 billion.1 In the last 10– 15 years, there have been advances in the treatment and prevention of stroke. This article overviews the medical management of stroke in the light of such advances in relation to patients older than 65 years of age.