Little information is available about stroke epidemiology in Eastern Europe. The purpose of our study was to determine and compare first-ever stroke incidence, 30-day case-fatality rates, and frequency of some risk factors among stroke patients in four Siberian cities, representing western Siberia, mid-eastern Siberia, and far eastern Siberia, Russia, during 1987–1988. There were 310 patients with first stroke in Novosibirsk, 447 in Krasnoyarsk, 51 in Tynda, and 24 in Anadyr. Age- and sex-adjusted incidence of stroke was 216.1 per 100,000 residents annually in Novosibirsk, 365.4 in Krasnoyarsk, 324.2 in Tynda, and 347.7 in Anadyr; age- and sex-adjusted 30-day mortality rates were 31.9, 37.1, 22.3 and 18.3%, respectively. Among the identified patients with stroke, the prevalence of arterial hypertension was highest in Novosibirsk (79%), the prevalence of myocardial infarction and diabetes mellitus was highest in Krasnoyarsk (12 and 11%, respectively), and the prevalence of current smoking was highest in Anadyr (29%) and Tynda (28%). Age- and sex-adjusted stroke incidence rates in Siberia are among the highest in the world. Stroke-incidence rates tended to increase somewhat from west to east and from south to north across Siberia, although 30-day mortality rates did not vary much in different regions of Siberia.