The recent development of potential therapies for acute stroke has focused attention on the time delay between stroke onset and presentation. We used the Duke/Veterans Administration stroke registry to collect data about this delay. Results were analyzed using Fisher's Exact Test and ridit analysis. Data from 457 patients at two hospitals were used. Only 42% (192/457) of patients presented within 24 hours of stroke onset, while 25% (116/457) presented within 48 hours and 33% (149/457) presented after 48 hours. Presentation time varied significantly with stroke type. A majority of patients with infarcts (64% [176/276]), stroke-in-evolution (54% [44/81]), and subarachnoid hemorrhage (54% [25/46]) did not present within 24 hours of stroke onset. Most patients with intracerebral hemorrhage (63% [34 of 54]) did present within 24 hours. Reasons for this delay may include patients' lack of awareness about the symptoms of stroke and lack of recognition of early signs by medical personnel. Because of this delay in presentation, a majority of patients may not be candidates for some therapies for acute stroke.