320-row CT enables dynamic CT angiography (4D CTA) of the entire intracranial circulation and whole-brain perfusion imaging (CTP). Sixty acute patients with neurological symptoms underwent various 320-row CT-specific protocols, including combined 4D CTA and CTP. Clinical and neuroradiological records were assessed for presumptive diagnoses, final diagnoses, supplementary and follow-up imaging studies. Additional diagnostic benefits delivered by 320-row CT were noted. Out of 60 procedures, 59 were accomplished successfully. Ischemia (n = 19), intracerebral hemorrhage (n = 7) and transient ischemic attacks (n = 10) were the major final diagnoses. Except one small cortical and two small subcortical infarctions all ischemias were diagnosed. All hemorrhages were diagnosed together with their underlying vascular pathology in five atypical cases. In conclusion, 320-row CT is a technically robust procedure being suitable for comprehensive neuroimaging of acute patients. It can provide dynamic angiographic and perfusion data of the whole brain and can deliver additional diagnostic information not available by standard CT.