Stroke is a leading cause of death and long-term adult disability worldwide. Rapid triage, diagnosis, and initiation of appropriate time-sensitive interventions are critical for optimizing outcomes after acute ischemic and hemorrhagic strokes. Neurocritical care units staffed by multidisciplinary teams provide comprehensive monitoring and management of stroke patients during the acute phase. This article outlines key principles and best practices in the neurocritical care management of ischemic stroke, intracerebral hemorrhage, and aneurysmal subarachnoid hemorrhage. Aggressive medical and surgical interventions alongside holistic supportive care measures are reviewed. As stroke systems of care and neurocritical care capabilities continue advancing, patient outcomes are improving.