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The modern reparative procedures are highly successful in terms of the cardiac outcome; they can be detrimental in regard to the central nervous system (CNS). Perioperative stroke is one of the most serious complications of cardiac surgery. Refinements and advances in surgical techniques, myocardial preservation and anesthesia have led to a decline in morbidity and mortality for cardiac surgical patients. Adverse cerebral outcomes, however, are increasing, largely because of a trebling of deaths caused by neurologic injury. Complications involving the brain are increasing substantially because older patients with advanced atherosclerotic vascular disease now have surgery, suggesting that advances in surgical and anesthetic techniques proven to provide better myocardial protection have not had an impact on reducing the incidence of ischemic brain injury. Careful preoperative evaluation process must be undertaken to identify patients who are at the highest risk of having perioperative stroke. This article provides a concise summary of a very important problem in contemporary cardiac surgery. The authors have concentrated on review of the predictive factors for perioperative stroke, identified by multivariate analysis in the recent studies. These factors taken together can identify patients, who are at high risk for perioperative focal cerebral ischaemic injury. Recognition of the high-risk group will facilitate prevention of stroke by modification of surgical procedures or pharmacologic intervention. Prevention is the most effective way of managing neurologic disorders.