Background Recurrent stroke following a transient ischemic attack or minor stroke is frequent but potentially preventable. The prevention outcome is, by and large, dependent on how well physicians understand and implement prevention guidelines. Yet, little is known about the scope of physicians' awareness and implementation of secondary stroke prevention guidelines in the mainland of China. This study aimed to identify the gaps between physicians' clinical practice and guidelines for secondary stroke prevention in China. Methods A nation-wide online survey with a 16-item questionnaire that reflects major components of the Chinese National Secondary Stroke Prevention Guidelines was performed between September 1, 2009 and October 31, 2009. Results A total of 3489 neurologists from third tier hospitals completed the survey. The percentage of the physicians who were aware of the control targets and prevention measures recommended in the Chinese national guidelines was generally lower than reported for developed countries. Conclusions Physicians in the mainland of China lack sufficient awareness of secondary stroke prevention guidelines. Continuing education is highly recommended. Chin Med J 2012;125(11):1867-1870