Elevations in serum troponin T in acute stroke have been suggested as an early marker of a poor outcome. A prospective, case-control study was undertaken to define characteristics associated with elevations in troponin T concentrations. Consecutive admissions to the Royal Adelaide stroke unit were assessed. Stroke outcome was determined using the modified Rankin scale. Elevated serum troponin T was seen in 12/109 (11%) of patients with stroke and was associated with more severe stroke, larger lesion volume and a worse outcome. However, as a prognostic indicator, elevations in troponin T had lower sensitivity for predicting death or dependence at discharge than the National Institute of Health Stroke Scale. Troponin T levels are elevated in a significant proportion of patients with acute stroke, principally those with large infarcts affecting the territory supplied by the middle cerebral artery but their value as a prognostic indicator remains uncertain.