BACKGROUND AND PURPOSE: With the increasing demand for rapid diagnosis and treatment of stroke, the telemedicine role of coordinating timely the efforts of the stroke team became important. We developed a system for rapidly exchanging diagnostic images and clinical and management information. METHODS: A system was created on the basis of communicating patient data and images between hospital systems and participating staff members in and out of the hospital through their standard, currently used handheld communication devices. The system is able to transfer clinical data, CT, MR, angiographic, intraoperative images, and expert opinion in real time. RESULTS: A pilot application of the system in our hospital showed successful information transfer, allowing medical staff to discuss patients' diagnosis and management using a Twitter system. CONCLUSIONS: The system (i-Stroke) may become a useful tool for acute patient management in the field of neurology and neurosurgery.