We assessed the use of echocardiography in the evaluation of stroke by recording M-mode and two-dimensional (2D) echocardiograms in 100 consecutive hospitalized patients. Of the 95 persons satisfactorily imaged with 2D echocardiography, 47 lacked clinical and routine laboratory evidence of heart disease; no potential embolic source or other findings that altered therapy was diagnosed by echocardiography. In the remaining 48 patients with clinical or routine laboratory evidence of heart disease, two with left ventricular thrombus as a potential embolic source were identified by 2D echocardiography. M-mode echocardiograms failed to detect the thrombus in either patient. No patients with left atrial thrombi, mitral stenosis, cardiac tumor, or vegetations suggesting endocarditis were identified. One patient had possible mitral valve prolapse. Echocardiograms in patients lacking other available evidence of heart disease are unlikely to yield findings that alter the clinical approach to patients with stroke; echocardiography in secretions patients with clinically evident heart disease may have greater clinical utility; additional study of the role of echocardiography in selected subgroups of stroke patients is indicated.