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In a series of 230 patients admitted to hospital with a stroke, the frequency and significance of epileptic seizures at onset was assessed. Thirteen (5.7%) suffered single or multiple witnessed seizures at the onset of their stroke. Seizures were evenly distributed among all pathological stroke sub-types but were restricted to lesions in the carotid artery territory. They indicated a poorer prognosis over the first 2 days. Six of the 13 presenting with stroke and seizures had prior seizures and, if they survived, continued to have fits. The five patients surviving with stroke and a first seizure were all fit-free after 30 months follow-up.