In the setting of acute stroke evaluation, CT is accessible, versatile, available, inexpensive, and, most importantly, fast. Its use extends beyond that of identifying intracranial hemorrhage. We have emphasized the importance of clinical assessment, supported by a systematic approach to unenhanced CT interpretation using the Alberta Stroke Program Early CT Score for determining the extent of early ischemic change. The use of CT bolus techniques (providing vascular CT angiography, CT angiography source images, and quantitative CT perfusion maps) can augment the clinical information obtained from unenhanced CT. CT is likely to remain the workhorse of acute stroke imaging for some time to come.