Stroke is a common neurological emergency and may occur in patients of all ages. Rapid assessment is crucial for patients with acute neurological symptoms suggestive of stroke because the opportunity for a positive outcome from thrombolytic treatment diminishes rapidly within the first few hours. Although plain non-contrast computed tomography of the brain is adequate to exclude haemorrhage and conditions such as malignancy, advanced multimodal imaging can be used to assist with decision making regarding the use of recombinant tissue plasminogen activator and mechanical clot-retrieval approaches without adding significant delay. Excellent outcomes are possible with the early use of reperfusion therapies, even when large areas of brain ischaemia are present, provided that there is evidence of potentially salvageable brain and that treatment can commence without unnecessary delay and hazard.