Most patients who have a stroke are evaluated initially by a primary care physician. For patients to benefit from new stroke therapies that must be initiated within a few hours of stroke onset, primary care physicians must be prepared to diagnose stroke and initiate acute treatment. This article provides information on the rapid and accurate diagnosis and management of patients with acute ischemic stroke. This information is particularly relevant due to the relatively high risk:benefit ratio associated with some acute stroke therapies, such as tissue plasminogen activator. Information is also provided about medical and surgical therapies to prevent subsequent strokes.