The "Japanese Guidelines for the Management of Stroke" (chaired by Yukito Shinohara) appeared in 2004, in Japanese, as a result of the collaboration of the Japan Stroke Society, Japanese Society of Neurology, Japan Neurosurgical Society, Japanese Society of Neurological Therapeutics and the Japanese Association of Rehabilitation Medicine. During its preparation, 106 stroke specialists from these societies checked and rated more than 110,000 publications from all over the world, including Japan. We thought it important to develop specific guidelines for Japanese patients, because there are race differences, because some of the approved drugs in Japan are different from those in other counties, and because reports published in Japanese have not been taken into consideration in the development of western guidelines. We also added the Japanese guidelines for use of t-PA in this outline, because there are some differences (e.g., in volume of t-PA) from the guidelines of western countries. Here, we present an outline the Japanese Guidelines for the Management of Stroke 2004 in response to requests, although some updating is already needed. The first revision of the guidelines is expected to be completed in 2008.