Prevention and treatment of stroke has changed substantially since the time of Franklin Delano Roosevelt who died of an intracerebral hemorrhage in 1945. As the understanding of stroke pathophysiology advanced, the beneficial effects of antiplatelet and anticoagulant drugs were recognized. Imaging of blood vessels by angiography made surgical therapies possible. Later noninvasive computerized tomography and magnetic resonance imaging distinguished hemorrhagic from ischemic stroke and gave new insight into stroke mechanisms. Stroke prevention became possible by selective management of stroke risk factors. Thrombolytics introduced 15 years ago provided the first actual treatment of ischemic stroke. The field of stroke continues to advance as medical and surgical treatments are refined and indications made clear, organized systems of care become standard, and new imaging techniques and endovascular therapies are developed.