Over the past 2 years, acute ischemic stroke has become a treatable disease. In this short period many consider that the intravenous use of tissue plasminogen activator is the standard of care for acute ischemic stroke for eligible patients; others consider it controversial. Further data has appeared suggesting that streptokinase is potentially dangerous for the same indication. Results of two neuroprotective agents have been published: tirilazad appears to be ineffective, whereas citicoline appears promising. Two large international trials have assessed the impact of aspirin and heparin on stroke showing only a minor benefit of aspirin in the acute management of stroke. Marked advances have occurred in imaging of ischemic acute stroke, mainly in the area of diffusion-weighted imaging, providing a significant research tool and arguably a useful clinical tool for the management and diagnosis of ischemic stroke. More data has appeared regarding the impact of cardiopulmonary bypass on the human nervous system and the impact of carotid stenosis on stroke during this procedure. Finally, more studies on prognosis in neurocritical care patients have appeared including the need for mechanical ventilation, size of stroke, and extent of supratentorial shift in patients with large strokes.