Stroke in the elderly has more major differences compared to young people. The first cause remains the atherothrombosis disease associated to the following risk factors: hypertension, diabetes, hypercholesterolemia, tobacco consumption. Lipohyalinosis of perforating arteries linked to blood hypertension inducing lacunar infarcts and atrial fibrillation are the 2nd and 3rd causes linked to age. The increase of the ageing population explains the rise of the number of stroke over 80 years. On a clinical point of view, the pseudo-bulbar syndrome is very frequent and explains the swallowing troubles and incontinence. Prognosis is characterized by a high risk of dementia (20 %). Primary and secondary prevention is very effective even in very old patients, on the risk of stroke. Fibrinolysis and stroke units have demonstrated their efficacy in stroke treatments over 80 years. We observed a decrease of case-fatality rates at any day with a delay in age of onset of stroke of 5 years in men and 8 years in women, suggesting an increase of life expectancy without stroke, reflecting a certain efficacy of prevention. The elderly may be more often included in therapeutic trials.