This study was performed to characterize the frequency, clinical presentation and etiology of cerebrovascular complications in patients with Fabry's disease. Thirty-three patients (age range 6-64 years) with Fabry's disease were reviewed, eight (24%) of whom suffered cerebrovascular complications. All patients developed ischemic strokes involving small arterial vessels which occurred in equal frequency in carotid and vertebrobasilar distributions. In six of these eight patients, a stroke occurred prior to age 40 years. Stroke frequently complicates Fabry's disease and represents a significant source of morbidity in patients affected with this condition; it usually involves thrombosis of small arteries affected by the disease process.