With the advent of therapy for acute stroke via in intraarterial or intravenous pathway, early diagnosis with physician education is extremely important. A common theme in all studies is the continued stress on patient and physician education, rapid triage and diagnosis with the use of CT scanning, xenon blood flow or diffusion MRI, cerebral protection, and revascularization with either carotid surgery or percutaneous angioplasty for an offending lesion, if such is identified. Although the current studies are cautiously optimistic, prospective randomized trials are needed for the evaluation of intraarterial thrombolytics as well as percutaneous transluminal angioplasty. It is important that the neurosurgical community be identified as physicians who can diagnose and treat the patient with an acute stroke.