Ischemic stroke mostly occurs in older patients with polymorbidity, therefore the approach to these patients needs to be interdiscplinary. Patients in peracute phase are threatened not only by neurological complications also by complications resulting from cerebral damage and disturbance of innervation like respiratory, cardiological and metabolical complications. In the peracute period the lowering of blood pressure is recommended only at values exceeding 200-220/120 mmHg; but the presence of an organ dysfunction as the hypertensive encephalopathy, pulmonary edema, acute myocardial infarction or acute renal failure requires prompt lowering of blood pressure. After an acute period it is necessary to take measures for the prevention of stroke recurrence, i.e. antithrombotic therapy and the use of antiplatelet agents for noncardioembolic stroke and oral anticoagulant therapy for the patients with cardiogenic embolism. Therapeutic influence to all standard cardiovascular risk factors as hypertension, lipids, diabetes, obesity and healthy life style is necessary. The role of internal medical consultant is also very important in patients with stroke who were up to the event healthy and searching for etiology and risk factors, especially in younger patients as well.