[Time is brain].

Ischemic stroke exacts a heavy toll in death and disability. Important progress have been made in terms of secondary prevention. Care of patients with acute stroke can also be improved. In 1996, the FDA approved Alteplase or rt-PA as a safe and effective treatment for stroke when given within 3 hours of the onset of neurological deficit. More than 10 years later, this treatment is still underused, mostly because of poor knowledge in the general population regarding stroke symptoms and implications, and inefficient emergency care and organisation. Organisation of primary stroke centers results in optimization in the care of patients with acute stroke, and improvement in outcomes, with reduction in death, dependency and need for institutional care.