Diagnosis and treatment of acute stroke has advanced considerably in the past 2 decades. Most notably, in cases of ischemic stroke, intravenous alteplase has become the standard of medical treatment despite its multiple contraindications and limited time window. More recently, trials have proven that endovascular thrombectomy is superior to medical therapy alone, advancing the standard of care for patients who present with acute ischemic stroke from a large vessel occlusion and salvageable brain tissue. The treatment of hemorrhagic stroke now involves the use of novel pharmacological agents and advanced minimally invasive technology. Important changes have also occurred at the levels of hospital organization and treatment decision-making. Such changes in organization and designation of hospitals with distinct levels of stroke care and the variety of stroke protocols now requires team work of emergency medical services (EMS), Emergency Department, stroke neurologists, neurosurgeons, and neurointerventionalists. This book provides an overview of the modern medical and surgical options for the treatment of patients with acute ischemic and hemorrhagic strokes. The pivotal role of EMS in prehospital evaluation and triage of a stroke patient and the levels of stroke systems of care are discussed. In addition, the current guidelines on the management of acute stroke, with the focus on early care of acute stroke patients at the Emergency Department and the first 24 hours of hospital admission, are reviewed. Each chapter contains a discussion of common clinical scenarios including initial management steps, practical points, and common pitfalls.