No drug has yet been shown to be unequivocally effective for acute stroke. Over the past decade, however, there has been an explosion in stroke research resulting in the development of novel therapeutic approaches. Therapies to improve arterial recanalisation and agents used to protect the brain from neurotoxic cellular damage are currently being evaluated. Tight control of physiological parameters may also limit neuronal damage. It is likely that within the next few years effective therapy will become available that will need a major change in the way that services are provided for stroke patients in the acute phase of their illness.