In Japan, stroke is a major cause of death and serious long-lasting neurological disabilities. Recently, the diagnosis and treatment of ischemic stroke has changed greatly. 1) Patients with TIA are more susceptible to ischemic stroke, and the susceptibility is predicted by the ABCD2score. 2) Brain natriuretic peptide (BNP) is a hormone released from the ventricular myocardium; BNP levels can predict new atrial fibrillation during hospitalization in patients with acute ischemic stroke. 3) In Japan, thrombolysis with intravenous recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke was approved in 2004, and the time window was extended up to 4.5 h in 2012. 4) Several novel oral anticoagulants (NOAC) have been developed over the last decade; the early initiation of NOACs in acute stroke and TIA patients with nonvalvular atrial fibrillation may be safe. More evidence-based treatment for stroke in Japanese people should be established.