The success of treatment with tissue plasminogen activator serves as an impetus to approach stroke as a medical emergency; diagnosis and treatment must be accurate and prompt. The initial evaluation should be straightforward and aimed at confirming ischemic stroke as the cause of the patient's acute neurologic impairments. Until the usefulness of diagnostic tests to demonstrate an arterial occlusion is established in emergent management, their application before treatment should not be mandated. Most individuals with acute ischemic stroke will receive their initial, key treatment in a community setting. Thus, strategies for emergent treatment should aim at management of patients whose strokes are diagnosed and first treated by emergency treatment and primary care physicians with the collaboration of neurologists.