After a person has had cerebral infarction (CI) (also referred to as ischemic stroke), the 30-day case fatality rate is approximately 20%. Survival after the first CI is approximately 70% at 1 year, 50% at 5 years, 30% at 8 years, 25% at 10 years, and about 8% at 20 years. The most common causes of death early after CI are transtentorial herniation, pneumonia, cardiac disorders, pulmonary embolus, and septicemia. Patients who present with altered sensorium and hemiplegia frequently die of herniation. Death from herniation occurs more commonly on day 1 or 2 after the onset of infarction than on any other days and considerably less frequently after day 7. Overall, nearly 40% of deaths from any cause occur within 48 hours. Other causes of death within the first month include pneumonia, cardiac disease, pulmonary embolus, and septicemia. The cause of death is dependent on the time after the initial stroke. In the first month, half of the deaths are due to the initial CI, approximately one quarter are caused by respiratory infection, and approximately one tenth are due to cardiovascular events. After the first month and during the first year after the first CI, respiratory infection and cardiac causes are far more common causes of death than neurologic factors related to the first CI or recurrent CI. Overall, during the first 10 years after initial CI, cardiac disorders and pulmonary causes are the most common causes of death, followed by neurologic factors as a result of the initial CI, recurrent stroke, and malignancy.

Significant independent predictors of death within 5 years after CI are age (increased age is associated with a decreased survival rate), previous myocardial infarction (MI), atrial fibrillation present at the time of stroke, and congestive heart failure anytime before stroke. Survival rates in patients with symptoms that resolve within the first 3 weeks after the CI (an event that is sometimes referred to as reversible ischemic neurologic deficit) are similar to those of patients with transient ischemic attack and better than those of patients with major CI.

Long-term CI mortality differs on the basis of the stroke mechanism. The 5-year mortality for each CI mechanism is as follows: large artery atherosclerosis with stenosis, 30%; cardioembolic, 50%; lacunar (small vessel disease), 35%; and stroke of unknown cause, 50%.