Stroke is an important medical and social problem. Views about etiology, pathogenetic mechanisms and therapy of patients with stroke have undergone significant changes. In this work, we elucidate contemporary theoretical and practical aspects of stroke treatment and prevention based on the results of multicenter clinical trials and experience of leading foreign and native specialists. Much attention is devoted to the pharmacotherapy of patients with stroke. It has been shown that neuroprotective drugs, in particular, antihypoxants with pleiotropic action (mexidol), play an important role in treatment of ischemic stroke.