Treatment of acute stroke in Germany has undergone major changes. To date almost half of all stroke patients there are admitted to one of 172 accredited monitoring stroke units, 80 of which were classified as inter-regional and 92 as regional. Following acute treatment, diagnostic/etiologic work-up and automated monitoring of vital functions are performed as well as adapted secondary prevention. Another important therapeutic goal includes early rehabilitation. International studies have established the superiority of stroke unit treatment over conventional care. Although the efficiency of monitoring stroke units in Germany was not shown in a randomized study, the prognostic benefit is hardly debated anymore. In 2006 a specific procedure standard (OPS) was introduced, increasing proceeds to compensate for the higher cost of monitoring and therapy but at the same time enforcing strict quality standards.