Stroke in an inpatient poses many complex, and frequently very challenging, issues. Not only does the patient present with past medical history and various comorbidities, but also has been admitted to the hospital for some other diagnosis. In addition, any organized response to these stroke patients has been largely ignored by health care. As a result, the response to stroke-like symptoms may vary from facility to facility, and patient to patient. This article presents 5 case studies in the emergency response to inpatient stroke occurrences in one urban medical center. The histories, admitting diagnoses, signs and symptoms, as well as therapeutic interventions and outcome are reviewed.