Cerebrovascular accidents (CVAs), or strokes, are a leading cause of disability in the United States. CVAs rank third to cardiovascular disease and cancer as a cause of death. CVAs are of 2 general types: 80% are ischemic in origin, and the remainder are hemorrhagic. Ischemic strokes may be embolic or thrombotic and involve small vessels or large vessels (primarily the carotid, vertebral, or middle cerebral arteries). It is estimated that each year, 600,000 Americans will have a CVA, and of these, 160,000 will be fatal. Of those who survive, the associated disability is often significant, and an estimated $50 billion per annum is spent on stroke care. Recent advancements in all aspects of care, including primary prevention, diagnosis, and management, have had an impact on the long-term prognosis of these patients. This article will highlight recent developments in overall stroke management and their impact on the dental and the surgical management of the stroke patient. PRIMARY PREVENTION The focus of primary stroke prevention is recognition and effective treatment of the known associated risk factors for CVAs. These include the following: hypertension, diabetes mellitus, smoking, hypercholesterolemia, and various cardiac abnormalities. Additional possible risk factors include alcoholism, use of oral contraceptives, and various hematologic (hypercoagulability) and metabolic abnormalities (Table I). Hypertension is the most important and modifiable risk factor. Both elevated systolic and diastolic pressure