Ginkgo biloba extract is widely used in the treatment of acute ischaemic stroke in China. An international team aimed to assess the evidence from randomised controlled trials and quasi-randomised controlled trials on the use of G. biloba extract in acute ischaemic stroke. The primary objective was to determine whether G. biloba extract improves functional outcome without causing undue harm in patients with acute ischaemic stroke. Secondary objectives were to assess the effect of G. biloba extract on neurological impairment and quality of life. All RCTs or quasi-RCTs comparing G. biloba extract with placebo or open control (no placebo) in patients with acute ischaemic stroke were included. Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data. Fourteen trials were identified, of which 10 trials (792 patients) were included. Four trials are awaiting assessment. In the 10 included trials follow-up was performed at 14 to 35 days after stroke. In all studies neurological outcome was assessed but none of them reported on disability (activities of daily living function) or quality of life. Only three trials reported adverse events. In nine trials, all of them were assessed to be of inferior quality; significant improvement in neurological deficit at the end of the treatment was used as the outcome measure. When analysing these trials together, G. biloba extract was associated with a significant increase in the number of improved patients. One placebo-controlled trial, assessed to be of good quality, reported neurological outcome as a continuous variable. It failed to show an improvement of neurological deficit at the end of treatment. No deaths or major adverse events were reported during the follow-up period.