Patients with acute ischemic and hemorrhagic stroke are often managed in a critical care setting. Disturbances in BP, body temperature, and serum glucose are commonly observed but their management remains controversial. The reversal of antithrombotic medications and prognostication are especially challenging for intracerebral hemorrhages. This review highlights recent clinical trials and the recommendations found in international guidelines relevant to these topics. We aim to provide a practical and brief, yet current, review of these more problematic areas of stroke care.