With the ageing of Western society, the absolute number of strokes occurring is likely to increase and the proportion of very old patients is sure to become greater.¹ This poses a double challenge: it will not only test the capacity of Western healthcare but also leave an increasing part of stroke management outside the comfortable confines of evidence-based medicine because younger patients tend to be included in stroke trials. Generalising the results of these trials to elderly people may cause problems for several reasons. The cardiac literature suggests that the …