Many strokes are treatable in the acute stage, provided patients are admitted soon enough. There is evidence that stroke unit care improves outcomes, and that the benefit does not depend on age, severity, and stroke subtype. In ischaemic strokes, specific therapies include intravenous recombinant tissue plasminogen activator, given as soon as possible and mechanical thrombectomy in case of proximal arterial occlusion, on top of thrombolysis in the absence of contraindication or alone otherwise, aspirin 300 mg, immediately or after 24 hours in case of thrombolysis, and, in a few patients, decompressive surgery. The time window for thrombolysis or thrombectomy can be extended beyond the usual 4.5h and 6h in a few patients who are likely to have significant penumbra. In intracerebral haemorrhages, blood pressure lowering and haemostatic therapy, when needed, are the two targets, while surgery does not seem effective to reduce death and disability.