Stroke remains a leading cause of mortality and long-term disability worldwide, necessitating prompt and effective management strategies to optimize patient outcomes. Acute stroke management involves rapid diagnosis, timely pharmacological and mechanical interventions, and coordinated multidisciplinary care. Among healthcare professionals, nurses play a pivotal role in the early identification, stabilization, and ongoing management of stroke patients, particularly during the hyperacute and acute care phases. This review article explores current evidence-based approaches in acute stroke management, including the use of thrombolytics, thrombectomy, and neuroimaging techniques, while emphasizing the critical role of nursing interventions such as neurological assessment, airway and hemodynamic support, medication administration, and patient education. Furthermore, it discusses the integration of stroke care pathways and the impact of nurse-led initiatives on patient outcomes. This review, involving recent literature, highlights the importance of collaborative, guideline-driven care and the evolving responsibilities of nurses in improving the survival and recovery of patients experiencing acute stroke.