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Few areas in emergency medicine have changed as rapidly, or with as much controversy, as the care of acute stroke. Systemic fibrinolysis, once vilified as dangerous and unproven, has emerged as the standard of care for a highly select patient population, with proven outcome benefit. Imaging modalities have evolved, but the clear superiority of magnetic resonance imaging is often negated by lack of access to this imaging study. Here, we present several recent studies of acute stroke. They address the incidence of acute stroke, validation of a score (ABCD2) to help identify patients at high risk, the role of imaging in the decision to administer systemic lytic therapy, functional outcomes at stroke centers, and performance of systemic lytic t…