Stroke care in Saudi Arabia lags behind developed countries with only one active stroke centre and seven centres providing thrombolysis out of >350 hospitals nationally; only two hospitals have a stroke team with implemented triaging pathways and beeper system. Via phone interview, we approached 83 neurologists and asked their opinion on stroke care practiced in Saudi Arabia. The study was approved by IRB. There are >350 hospitals in Saudi Arabia and only one centre has a stroke unit, and only seven provide thrombolysis. It is estimated that the number of cases treated with thrombolysis is 50/year for 24 million people. Overall, the neurologists indentified their priorities for improving care as: establishing stroke units; increase public awareness; and training health care providers and collaboration. The neurologists we interviewed view acute stroke care in Saudi Arabia as inadequate. This is an urgent call for actions to start organising nation-wide stroke care to close the existing huge evidence–practice gap.