OBJECTIVES: To assess the first Japanese guideline for the management of stroke developed in 2004 (Int J Stroke 2007; 2: 133-135) by a formal method. METHODS: This guideline was critically appraised using three instruments of AGREE, COGS and Shaneyfelt by independent reviewers from the developers. They consisted of 22 stroke physicians, 8 general physicians, and 11 nurses. Best evaluation corresponds to 100% of response rate. RESULTS: A response rate was ranging from 66 to 91% with regard to each of many checklists . There was no distinction among the appraisal instruments. Among those, the dimensions of scope/purpose (89%), rigor of development (83%), and clarity/presentation (76%) were highly approved in integrity of the guideline, yet, relatively lower in editorial independence (71%), stakeholder involvement (70%), and applicability (69%). Nurses tended to provide a more faborable response. CONCLUSIONS: The Japanese guideline for the management of stroke was first formally evaluated and turned out to be fairly acceptable.