The aim of this survey is the characterization of the present value of multi-slice computed tomography (MSCT) for the assessment of hyperacute cerebral ischemia based on our experience and a review of the literature. MSCT is compared with single-slice CT (SSCT) as to the diagnostic value of standard cranial CT, CT angiography (CTA) and perfusion CT. CTA obtained with MSCT surpasses CTA obtained with SSCT. For perfusion CT, the value added by MSCT is small. With regard to standard cranial CT, MSCT and SSCT are considered equivalent. CTA and perfusion CT should be used in patients with acute stroke if the indication for thrombolysis is entertained but diffusion and perfusion weighted MRI cannot be carried out. This applies to both SSCT and MSCT. If advanced MRI and advanced CT are available, MRI continues to be the preferred imaging modality.