An approach to managing acute ischemic stroke includes recognition, investigations, treatment, and secondary prevention. Firstly, facial drooping, limb weakness and slurred speech are some common signs that should raise the suspicion for stroke. Upon presentation, investigations, including the national institute of health stroke scale and a CT head, should be done to rule out intracranial hemorrhage and diagnose an ischemic stroke. The treatment principles for an acute ischemic stroke focus on removing or dissolving the occlusion to maintain or reinstate perfusion of the brain. Finally, patients suffering ischemic stroke should be admitted to the acute stroke unit and monitored for complications. Basic medical management of comorbidities should also be considered to prevent subsequent ischemic episodes. This article will explain each of these processes in more detail to help develop a basic approach to the management of an acute ischemic stroke.