Although stroke units and systemic thrombolysis are effective, use of these two treatment methods is restricted because of a widespread lack of expertise. New telecommunication technologies can help to overcome the lack of emergency-provider support in neurologically underserved areas. The status of "telestroke" as the application of telemedicine for acute stroke is presently passing from feasibility to routine use. Teleneurological examination is reliable and systemic thrombolysis can be extended with telemedical consultation. Telestroke, however, offers even more potential in overall acute stroke management. On the one hand, it provides rapid access to specialised interventions through initiation of interhospital transfers, and on the other hand, it might lead to major improvements in basic on-site stroke therapy.