Vascular diseases including stroke increase with advancing age. Their occurrence reflects the lifestyle and eating habits of a society. In industrialized countries stroke causes a significant loss of DALYs. Each year, approximately 150 persons per 100,000 inhabitants suffer a stroke. Half a year after the stroke, two of three stroke victims are dead or dependent, and all stroke survivors are at risk to suffer recurrent strokes. Stroke is due to a focal ischemia. In the core of the ischemia blood flow is reduced substantially, mostly to a level below the infarction threshold. In the borderzone collaterals can still provide sufficient blood to preserve the neurons though the reduced blood flow does not suffice for neuronal functioning. This state below functional and above infarction threshold is called penumbra. When the stroke signs are recognized early and the occluded vessel is recanalized with thrombolytics or mechanically the brain tissue in the penumbra can be preserved and the fate of the stroke victim is improved compared to spontaneous course. Before administration of thrombolytics neurological examination and imaging of the brain using CT or MRI are necessary. After stroke, survivors will benefit significantly from secondary prevention. In order to perform an individually tailored prevention, additional investigations such as neurovascular and cardiac ultrasound, cardiac monitoring and blood examinations are necessary to define the cause of the stroke. In addition, recognition and modification of individual vascular risk factors are of paramount importance.