Stroke – now a disorder of middle age – so act FAST It is now just on 8 years since I sustained my stroke in May 2010, at the age of 61 years. I was due to fly out to the United States the following morning, when I was bending down in the floor of my car when it happened. First my right hand would not respond and then my right leg would not support my weight. I tried to call out to my wife, but could only grunt. I crawled to the front door and my intensivist wife called 000 and the ambulance was there in 3 min. The paramedics recognized the four classic signs incorporated in the acronym FAST. This acronym was developed in the UK in 1998 by a group of stroke physicians, ambulance personnel and an emergency room physician, and was designed to be an integral part of a training package for ambulance staff (Harbison et al. Stroke 2003; 34: 71–6), and is now used throughout the world including Australia and New Zealand. The acronym stands for: F Facial drooping. A section of the face, usually on one side that is drooping and hard to move. This can be recognized by a crooked smile. A Arm weakness: the inability to raise one’s arms fully. S Speech difficulties and inability or difficulty understanding or producing speech. T Time. If any of these symptoms are showing, time is of the essence and the importance of calling emergency services or go straight to hospital. The other message from the FAST campaign is not only time, but also the importance of education of the public to the recognition of the early signs of stroke. Mine was a ‘stroke of luck’, as I was taken by ambulance to a metropolitan hospital with a stroke unit, received thrombolysis and made an excellent recovery. The cause of my stroke was a patent foramen ovale and probably, therefore, a paradoxical embolus caused by my bending down in the car, with a Valsalva effect (Waxman. MJA 2010; 193: 468). My experience with a rapid hospital assessment and early intervention with thrombolysis after sustaining an acute ischaemic stroke with full recovery emphasizes that time is critical. In February 2018, Public Health England released new estimates of the incidence of first stroke in England, and relaunched its FAST campaign (https://www.gov.uk/government/news/new-figures-show-larger-proportion-of-strokes-in-the-middle-aged). The new estimates show that about 57 000 new strokes and 32 000 stroke-related deaths occur every year in England. Of those who have experienced a stroke, about one-quarter leave hospital with moderate or severe disability. While overall stroke incidence increases with age, 38.2% of all strokes are now in the 40–60-year age group, compared with 33% in 2007. Stroke is increasingly becoming a more common problem for the middle-aged individuals. Many middle-aged individuals might not be aware that they may have important risk factors, including hypertension and atrial fibrillation, or, as in my case, an unrecognized patent foramen ovale. The other important risk factors in middle age include obesity, alcohol use and physical inactivity. Treatment and prevention of risk factors for stroke are equally crucial and need to be acted upon fast, or else the stroke burden will shift further to younger age groups (Lancet 2018; 391: 514). The Stroke Foundation in Australia released their updated clinical guidelines for stroke management in 2017, using the best available evidence, updating and superseding those for 2010, and where approved by the National Health and Medical Research Council on 25 July 2017 (https://informme.org.au/en/Guidelines/Clinical-Guidelines-for-Stroke-Management-2017). These guidelines provide a series of recommendations to assist decision-making in the management of stroke and transient ischaemic attacks in adults. Telemedicine is also having an impact for patients who may not necessarily be close to a metropolitan stroke unit. The implementation of the Victorian Stroke Telemedicine (VST) programme across rural centres in Victoria has had a significant impact on the early treatment of patients with stroke symptoms with a telemedicine link to a consultant neurologist from emergency departments throughout rural Victoria (www.vst.org.au). In the initial 12-month implementation of VST, 62 patients arrived within 4.5 h with stroke thrombolysis use increased from 17% to 26% and more patients who received thrombolysis were discharged to home or rehabilitation with significant fewer transfers to other acute care services (Bladin et al. Intern. Med. J. 2015; 45: 951–6). The programme now services 16 regional hospitals and to date, 3000 consultations have been provided. So, what is my take-home message? Consider lifestyle changes to reduce your chances of stroke, and be aware that stroke may affect individuals of any age, particularly those in middle age and some at the height of their surgical careers and act FAST.