The management of patients with cerebrovascular ischemic disease (ICD) is rapidly changing due to newer diagnostic approaches and therapies being developed. In the present article, the author reviews part of his experience in the clinical and basic fields of ICD which is the most common neurologic problem leading to acute hospitalization. Clinico-anatomic categories of ICD as well as prognosis and differential diagnosis are discussed. Data from basic and research are analysed with a main focus on their implications for clinical management.