A panel of stroke experts from the Gulf and Iran region convened a consensus meeting to discuss how the Covid-19 pandemic has affected stroke care in the region. Lower stroke admissions were observed locally, but acute stroke care has largely been maintained in their centres despite the challenges of staff and resource shortages, and public fear of the virus. This article provides a snapshot of the pandemic in the region, its impact on local stroke care, highlights the approaches and practices shared between panellists in order to protect stroke care pathways during this uncertain period, and provides a guideline that is simple and easily adaptable to different locations. The intent is to protect stroke care pathways through Covid-19 risk stratification, infection control measures, and ensuring that all stroke patients have a full Covid-19 diagnostic assessment. Opportunities for increasing the use of telemedicine to reduce physical contact between patients and healthcare workers is also discussed.