Although cerebrovascular disease is the third most common cause of death in the United States, there is little information about the actual mechanism of death in patients with an acute, terminal stroke. We have investigated the records of 200 patients who were admitted to the Evanston Hospital with the diagnosis of stroke, died, and had autopsies. Our data show that patients who died within a week after onset presented important differences in the probable causes of death from those who died later. In the latter group, death appeared much more frequently to be due to nonneurologic diseases such as pneumonia, pulmonary embolism, and urinary tract infections.