It has been well documented that stroke is among the leading causes of death and disability, both in the United States and worldwide (www.strokeassociation.org). This has continued to be the case despite recent advances in the treatment of acute events, which have proven to decrease disability and improve outcomes. Over recent years, there has been significant growth in the field of acute stroke care and stroke systems of care. This includes improvements in the management of acute stroke as well as the development of stroke units, which focus on a multi-disciplinary approach for patients with cerebrovascular disorders. This organized inpatient care practice appears to improve outcomes by decreasing mortality and reducing dependency without increasing length of stay, when compared to a general medical ward (Stroke Unit Trialists' Collaboration, Cochrane Database Syst Rev 9(9):CD000197). This chapter will explore some of the new advances in care for the acute stroke patient, as well as the benefits of a stroke unit approach to care. Some of the basic components that make a successful stroke unit will be reviewed, and the development of telemedicine will be introduced when considering the future practice of care in these units.