Stroke is the third leading cause of death following heart diseases and cancer, Approximately 20-25% of these people will die within 1 year of their stroke, also it is the most common cause of adult disability. Despite advances in acute and prophylactic therapies, rates of stroke and stroke-related deaths continue to increase.Stroke occurs when the blood supply to a part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. An exceptional character of the brain is that more any other organ the brain depends from minute to minute to an adequate supply of oxygenated blood. Constancy of cerebral circulation is assured by series of barorecptors and vasomotor reflexes and the centers in the lower brain stem. Brain tissue deprived of blood undergoes ischaemic necrosis or infarction ,also referred to as a zone of softening or encephalomalacia. In cerebral hemorrhage, blood leaks from the vessel (usually a small artery) directly into the brain forming a haematoma in the brain substance and spreading into the ventricles and subarachnoid space. The mass of clotted blood causes disruption of the tissue and pressure on the surrounding brain. Blood within the subarachnoid space, mainly the result from aneurismal rupture may cause cerebral ischaemia through a mechanism of the constriction of the vessels of the circle of Willis and their primary branches (vasospasm).Understanding the exacts pathophysiological events that happen following disruption of cerebral blood flow and the ischaemic cascade which is followed by series of steps leading to neuronal death.The discovery of this ischaemic cascade gave rise to new concept in the development of modern therapies and medications most of them are under trials and only one therapy was approved, the Recombinant tissue Plasminogen activator. r-tPA. The neuroprotective agents in stroke are various classes of drugs together with physical methods and gender hormones aiming at reducing the size of infarction and minimizing the resulting disability. Many classes of neuroprotective agents are established. They include calcium channel antagonists, CDP choline, the free radicle scavenger tirillized, anti intracellular adhesion molecule 1 (ICAM-1) antibody, GM–1 ganglioside, clomethiazole, the sodium channel antagonist, fosphyntion and piracetam. Physical methods as surface cooling and hypothermia. The gender hormones as estrogen, anticoagulants as low molecular weight heparin and insulin. RtpA if given in its optimal timing causes destruction of the thrombus with no or minimal disability. Administration of rtPA was studied to compare between arterial administration of the drug which was proven to be superior on the venous administration, however the discovery of the thrombolytic therapy and its efficacy in treatment of thrombotic strokes has revolutionized the strategies of treatment of cerebrovascular diseaseIn the future, optimal therapy may be achieved by combining neuroprotective agents with complementary mechanisms in a "stroke cocktail" Because these drugs most likely will not display adverse effects in patients with hemorrhagic stroke, ambulance crews could begin administering this stroke cocktail in the field. Upon arrival at the hospital, the patient would undergo imaging studies of the head, and assessment for potential administration of a medical or mechanical thrombolytic would take place.