Ischemic stroke represents a huge global burden, being the leading cause of physical disability and the third leading cause of death worldwide1. Although rigorous epidemiological data from Pakistan are lacking, stroke is certainly the commonest reason for admission to a neurology ward in our part of the world, as elsewhere. Recent years have seen a number of new developments in the clinical approach to stroke, including in the areas of diagnostic work-up, acute treatment and secondary prevention. These developments enable the formulation of clinical practice guidelines for achieving standardized management of ischemic stroke, with the overall aini of improving the care of stroke patients. This article presents a set of guidelines that may be useful to clinicians involved in the care of stroke patients in Pakistan. The term 'stroke' is used here to refer exclusively to ischemic brain infarction; this paper does not address intracerebral hemorrhage.