Patient-related factors may make MRI impractical in an emergency setting. The authors prospectively assessed the limitations on obtaining MRI in 141 consecutive acute stroke patients. MRI was not feasible in 28 (19.9%) patients owing to patient-related issues. Apart from MR contraindications (n = 14; 9.9%), the main factors precluding MRI were a diminished level of consciousness, vomiting, agitation, and hemodynamic compromise. In the subgroup of patients ineligible for MRI because of medical reasons (n = 11), intracerebral hemorrhage was frequent (n = 9; 73%).