Hypoxic-ischemic neuronal death has long been considered to represent necrosis, but it now appears that many brain neuron sundergo apoptosis after either global or focal ischemic insults. This event is probably substantially distinct from ischemia-triggered excitotoxicity, which tends to produce necrosis. While many questions remain unanswered, the concept of ischemic apoptosis has raised exciting prospects of combining anti-apoptotic with anti-excitotoxic treatments to achieve heightened therapeutic benefits in the brains of patients traumatized by cardiac arrest or stroke.