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Stroke medicine could once be summed up as: “strokes happen: get used to it.” It wasn’t really until the 1990s that these devastating events were given due attention and specialised care in stroke units was widely shown to improve outcomes. But how? Something was happening on these units which did not routinely happen on general medical wards, and the obvious place to look is at the prevention of complications, especially infection. A systematic review of 17 trials of stroke units has been further analysed (Stroke 2007;38:2536–40) to look for specific differences in care, and confirms this: most improvement in stroke outcomes has not come from high-tech interventions such as thrombolysis or neuroprotection, but from more attentive medical and nursing care. Nonetheless, the prevention of stroke remains even more important, and recently we have become more aware of the need to regard transient ischaemic attacks as a serious herald of stroke in much the same way as we regard unstable angina as a herald of myocardial infarction. …