Stroke remains one of the most important clinical diagnoses for which patients are referred to the radiologist for emergent imaging. Timely and accurate imaging guides admission from the emergency department or transfer to a hospital with a dedicated stroke service, triage to the intensive care unit, anticoagulation, thrombolysis, and many other forms of treatment and management. It is important to approach each patient's imaging needs logically and tailor each work-up, and constantly to review the entire process for potential improvements. Time saved in getting an accurate diagnosis of stroke may indeed decrease morbidity and mortality. This article discusses the current management of stroke imaging and reviews the relevant literature.