Stroke is a leading cause of death and disability in Europe. Standards of care vary widely, and the introduction of simple standards will improve mortality and morbidity. It has been shown, in the absence of any medical treatment for acute stroke, that improving the organization of care for people with stroke significantly improves outcome. Recommendations are made for simple changes to the organization of care. Preventative measures after first stroke reduce incidence of subsequent stroke: these could be made widely available. Rehabilitation for those with persisting disability should be patient centred and commence immediately after the patient is alert and medically stable. Urgent research is required to find out which components of rehabilitation are important, and measures should be in place to ensure that all who require rehabilitation receive it from appropriately trained professionals. Population-based monitoring systems covering incidence, case fatality, mortality and disability should be put in place in all European Member States by the year 2005.