Background and Purpose In Lithuania, only routine mortality statistics have thus far provided data on the epidemiology of stroke. This study aims to assess the mortality, incidence, and case-fatality rate of stroke in the city of Kaunas, Lithuania, during 1986 to 1988. Methods A community-based stroke register was set up in 1986 to collect data on all suspected events of acute stroke that occurred in the population aged 35 to 64 years permanently residing in Kaunas. Crude and age-standardized attack rates, incidence, mortality, and case-fatality rates were calculated for the period studied. Results Among men, the average age-standardized incidence of stroke (referring to first-ever events) was 230/100 000, the attack rate (all events) was 300/100 000, and the mortality from all strokes was 68/100 000. Among women, the corresponding rates were 131/100 000, 154/100 000, and 35/100 000, respectively. Of 973 acute stroke events registered, 80% were first-ever strokes. The age-adjusted 28-day overall case-fatality rate and the case-fatality rate of first-ever stroke were 23.3% and 19.8% in men and 21.8% and 21.3% in women, respectively. Conclusions The findings from this first assessment of the incidence and mortality of stroke show that in the mid-1980s both were high in Kaunas compared with other countries. The case-fatality rate was similar to that reported for most other European countries. Further investigations are being carried out to assess the trends in mortality, incidence, and risk factors of stroke in the Kaunas population.