Background: Stroke is a clinical syndrome consisting of rapidly developing clinical signs of focal or global disturbance of cerebral function that lasts more than 24 hours; and/or leads to death with no apparent cause other than a vascular -brain-origin. Stroke globally is the second leading cause of mortality; however, it is the third most common cause of mortality in low-income countries. This disease is causing a huge global burden on the economy and health care systems, with one-third of patients being dependent (partially or completely) on a caregiver. Thus, management and treating such cases is a vital and important aspect in the whole medical field, starting from the emergency department up till admission to the ward and long term follow up. Objectives: We aimed to review the literature reviewing the pathophysiology of acute ischemic stroke, clinical features, risk factors, diagnosis, and management of this disease in the emergency setting. Methodology: PubMed database was used for articles selection, papers on were obtained and reviewed. Conclusion: Acute ischemic stroke is one of the most common and fatal diseases that physicians in the emergency departments face almost on a daily basis. Many options of treatment are available, with a significantly better outcome when given early, public knowledge of alarming signs is of utmost importance. Moreover, many new treatment options are being studied and may prove to be the most needed breakthroughs in dealing with one of the greatest causes of morbidity and mortality worldwide.