There is evidence that an improvement of the diagnostic abilities could have a value for prognosis and therapy of the ischemic stroke. New neuroradiological strategies could be used with an amelioration of the evaluation and standardization of the ischemic damage. The value of early vascular sign remains controversial as a predictor of patient outcome. Early parenchymal changes are related to a poor outcome. The risk of hemorrhagic transformation increases with trombolytic therapy and especially with the onset of therapy. Between hemorrhagic transformation, only the large hematomas seems to be related to early deterioration and death. Brain Computed Tomography (CT) examination can give information about prognosis and therapeutic choice.