Stroke care in Britain has been criticised as "shocking" by The Lancet medical journal.
An editorial in the magazine says the condition "still lies in the shadow of its big sister" - heart attack - despite two decades of research proving the benefits of good treatment.
Disabilities caused by stroke are expected to soar in ageing populations, like Britain's, in the coming years.
The Lancet says recent research by the Royal College of Physicians in London showed as many as a quarter of stroke patients do not receive the best treatment in a specialist unit.
The report showed just 17 per cent of the 11,369 patients surveyed were admitted to an acute stroke unit within four hours of hospital admission, and as few as 21 per cent had a brain scan within three hours.
Good stroke management is considered to include 90 per cent of a patient's stay being in a stroke unit, rapid screening for swallowing difficulties, a brain scan within 24 hours, aspirin, assessment by a physiotherapist and an occupational therapist.
Weighing the patient, assessing their mood and rehabilitation goals agreed by a multidisciplinary team are among the other essential recommendations along with rapid initial assessment, clot busting drugs when appropriate and rehabilitation to aid recovery.
Although an estimated 15 per cent of patients were eligible for the clot busting treatment, known as thrombolysis, only one per cent received it.
The editorial said: "These are shocking findings. Stroke services in England, Wales, and Northern Ireland are offering not only unequal care, but also care that falls below the standards set out in the National Stroke Strategy."
But it adds that the strategy has stimulated improvement in stroke care and things are better now than they were in 2006. While money and resources such as inadequate staffing are clearly a problem, The Lancet also advocates higher priority for stroke care and increased public awareness.
A successful advertising campaign in the US, using the slogan "time is brain", showed the importance of early recognition of stroke symptoms. A similar campaign is underway in the UK.
The editorial said: "Increased use of FAST (one or more of Facial weakness, Arm and leg weakness, Speech problems, then Time to call an emergency ambulance) to diagnose stroke and therefore take patients directly to an acute stroke unit would enable rapid admission to the appropriate place.
"At present, many in the UK end up in general admissions units in hospitals where access to scanning, thrombolysis, and care by appropriate therapists is delayed. Increasing the priority with which ambulances respond to calls for suspected stroke would also help."
It added: "Stroke is a medical emergency. Despite almost two decades of research that has proven the benefits of stroke units, thrombolysis, and aspirin in reducing mortality and disability, stroke still lies in the shadow of its big sister, heart attack.
"Yet stroke-related disability is expected to substantially increase as populations age. In view of the worldwide shortage of health care professionals and other resources to implement the strategies that work for stroke care, never has 'time is brain' seemed more appropriate."
The Stroke Association described the audit as "a wake up call."
Spokesman Joe Korner said: "This is the first audit since the National Stroke Strategy was launched and demonstrates that really encouraging improvements are being made in stroke care.
"But it also reveals areas where a lot of work is needed for stroke services to reach the quality markers set out in the National Stroke Strategy.
"This audit is a wake up call: we need to see acceleration in the progress that is being made, and a step change in those areas which are still not providing the quality of treatment that everyone who has a stroke deserves."
The Telegraph, 1st May 2009