Of 156 stroke patients prospectively and consecutively evaluated, one-third had a homonymous hemianopia. Of those 52 patients, 46% had a horizontal conjugate gaze paresis at the time of presentation. This gaze paresis was most commonly seen with large hemispheric stroke. The overall prognosis in patients with a gaze paresis was poor. The 30-day case fatality rate was 49% which was significantly higher than for stroke patients presenting with homonymous hemianopia without a gaze paresis.