Background: Stroke is a condition that is described as a clinical syndrome where a rapid focal or general neurological deficit appears as abnormal signs and symptoms and lasts for more than 24 hours. It can be classified as ischemic and hemorrhagic depending on the cause. It will lead to severe complications and may progress into coma and death. Overall, stroke is the third cause of mortality and, in some demographics, is considered the second most common cause of death. Diagnosing this disease is of vital importance because it will impact the start of the treatment and the overall outcome of the patients. Luckily, the treatment options have advanced in the last 20 years with multiple options depending on the clinical presentation. Objectives: We aimed to review the literature reviewing pathophysiology of acute ischemic stroke, risk factors, clinical features, evaluation, diagnosis, and management of this disease; with a focus on the medical approach. Methodology: PubMed database was used for articles selection, papers on were obtained and reviewed. Conclusion: Internal medicine clinicians must have a solid background clinically with a high clinical suspicion in order to identify stroke as soon as possible. This will impact the management approach and choices and prognosis of patients. Moreover, many treatment regimens and options have been heavily studied with new possible breakthroughs being under the scope in upcoming studies. These new modalities of management may offer a better future for patients, and help the clinicians in treating a major morbidity and mortality cause globally.