Time is brain, as all good stroke physicians know. Quite how, therefore, a fence-sitting, slow-coach UK-trained neurologist like me has ended up as a stroke neurologist in Calgary, one of the cradles of rapid stroke medicine, remains something of a mystery (and never more so than when my pager goes off at two o’clock in the morning for an “acute run”). And yet, here I am and thriving on it. Back home, the UK is just starting to take acute stroke seriously, and the recent publication of its National Stroke Strategy, emphasising the importance of thrombolysis for acute ischaemic stroke and speedy secondary prevention for high-risk transient ischaemic attack (TIA) patients, is a welcome step forward. Calgary’s claim to fame, however, is that it has “been there” and “done that” for quite some time now.

The publication of the now classic NINDS paper showing that intravenous tissue plaminogen activator (tPA) improved the outcome of acute ischaemic stroke coincided with the arrival of Alastair Buchan as the new professor of neurology in Calgary in 1995. Fascinated at the prospect of being able to influence the pathology of stroke rather than simply encouraging patients to recover from it, he quickly set about creating a system to administer the new treatment. Special permission was obtained to use intravenous tPA for stroke long before it was formally approved for the purpose in Canada as a whole. Without anyone else to help him, Alastair turned on his pager and, in his inimical style, simply became the acute stroke service, available 24/7. Over time the service grew with the addition of fellows and an active research programme, and the profile of acute stroke medicine in Calgary shifted from low-brow to cool.

Charting almost virgin territory, the team invented the ASPECTS system for reading acute stroke CT …