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Acute ischemic stroke is a medical emergency. The initial evaluation of the potential stroke patient often occurs in a high-acuity area. Medical personnel responsible for establishing intravenous access, initiating cardiorespiratory monitoring, performing blood draws, and performing electrocardiography compete for the patient's attention. Additionally, the presence of aphasia or neglect may limit the patient's ability to provide accurate information. The neurological examination should focus on identifying signs of lateralized hemispheric or brainstem dysfunction consistent with stroke. The National Institutes of Health Stroke Scale (NIHSS) is a validated scale that has gained widespread acceptance as a standard clinical assessment tool. The chapter discusses evidence-based ischemic stroke treatment strategies. Determination of stroke mechanism and prompt initiation of secondary stroke preventative strategies such as anti-thrombotic therapy, aggressive risk-factor management, and carotid revascularization in carefully selected patients provide an opportunity to reduce the future burden of stroke.