BACKGROUND Most guidelines recommend that patients should refrain from driving for at least one month after stroke. Despite these guidelines, and the fact that patients post-stroke may be at an increased risk for driving impairment, many patients report resuming driving within the acute phase of injury. The aim of this study was to investigate the driving performance of patients with acute mild stroke. METHODS The current study compared the driving simulator performance of ten patients with acute mild ischemic stroke (>48 h and <7 days) to that of ten healthy, age- and education-matched controls. RESULTS During the City Driving and Bus Following Scenarios, patients on average committed over twice as many errors (e.g., collisions, center line crossings, speed exceedances) as controls (12.4 vs. 6.0, t(18)=2.77, p<0.01; and 8.2 vs. 2.1, t(17)=2.55, p<0.05; respectively). Although there was no difference between patients and controls in the number of errors committed during simple right and left turns, patients committed significantly more errors than controls during left turns with traffic (0.49 vs. 0.26, U=26.5, p<0.05). CONCLUSION Results suggest that patients with acute mild ischemic stroke may be able to maintain driving performance during basic tasks (e.g., straight driving, right turns) and that deficits may become apparent during more complex tasks (e.g., left turns with traffic, bus following). The results highlight the importance of healthcare professionals providing driving advice to their patients post-stroke, particularly in the acute phase of injury.