Advances in stroke therapy have followed diverse paths over the past 2 years. Recent clinical trials have investigated the use of thrombolytic agents, anticoagulants, antiplatelet drugs and neuroprotective agents in acute stroke patients. The positive results of the National Institutes of Neurologic Disease and Stroke tissue plasminogen activator trial have increased interest in the field of acute stroke therapy and initiated significant changes in the management of stroke patients in the medical system. A new antiplatelet drug and a number of trials involving HMG Co-A reductase inhibitors are important advances in the secondary prevention of stroke.