- A substantial portion of acute stroke cases occur in hospitalized patients. Some of these events take place in a ward that does not usually treat acute stroke patients. This paper hopes to enhance the awareness and management of acute stroke episodes in wards that are not used to treating such cases. Using an example of an acute stroke patient in a general surgical ward, we discuss the tribulations of recognition and primary treatment of acute stroke within a hospital using the AHA guidelines and present recommendations for treating such cases. We report a case of a patient admitted to a general surgical ward for treatment of a perianal abscess, who complained of new onset of right-sided weakness. In order to assess the risk of acute stroke, the resident physician performed two screening tests: the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS). Both were found to be positive. In accordance with these results, a decision was reached to treat the case as an acute stroke. An urgent head CT and neurologist examination were performed and the patient received thrombolytic treatment within 90 minutes of the appearance of symptoms. Five days later the patient was discharged from the neurology ward with minor retained symptoms. The AHA recommendations for acute stroke are directed at patients who undergo an acute stroke out of hospital. In order to improve management of cases occurring in-hospital there are several important recommendations to consider: (1) The medical staff must be attentive to signs and symptoms that can indicate an acute stroke. (2) Two screening tests that are usually used in the pro-hospital environment can be used in the hospital as well (CPSS and LAPSS). (3) In patients considered to have a high probability of acute stroke, according to the screening tests, a maximal effort should be made to insert the patient into a "fast track" path that will allow rapid thrombolytic treatment for eligible patients. (4) One must complete a head CT and neurological assessment as fast as possible. If the patient is found to be suitable for thrombolytic therapy, he can then receive it with maximal benefit.