Many studies have looked at issues surrounding why people delay in accessing healthcare after they have experienced a stroke, but no published studies on this subject have been conducted in West Virginia. To identify the factors causing patients to delay treatment for a stroke, we conducted a concurrent chart review of 64 acute stroke and TIA patients presenting at Charleston Area Medical Center from April 1, 2003 to July 21, 2003. Results showed that the majority of patients arrived beyond the critical three-hour limit for tissue plasminogen activator (tPA) medication. The patients who reported speech problems and confusion as their initial symptoms, those who lived within 15 miles of the hospital, and those who used ambulance transport, were most likely to arrive at the hospital in less than two hours. On the other hand, the patients who were less likely to arrive within two hours were those who were alone at symptom onset, those who had weakness as a prominent symptom, as well as those were younger and had commercial insurance. We recommend educating the community about the symptoms of stroke and focusing on the fact that stroke is a medical emergency and calling 911 is necessary.