The trends in incidence, 28-day mortality and 28-day case fatality of stroke during the period 1986–1993 were assessed in the population aged 35–64 years in Kaunas, Lithuania. The Kaunas community-based stroke register was the source of data. During the study period the incidence of stroke increased by 14% in men and remained stable in women. The overall mortality from stroke increased by 34% in men and by 10% in women. The case fatality of all strokes as well as that of first ever strokes increased during the study period approximately by 20%. These results suggest that the increase in mortality from stroke in Kaunas is mostly due to an increase in the severity of the disease, especially among men. In addition, also the number of new stroke events increased in men, partly explaining the larger increase in mortality from stroke observed among men than among women. Appropriate strategies for the primary prevention of stroke are required in Lithuania. To achieve this aim, future studies are also needed to estimate relative and population-attributable risks for various risk factors of str