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Background: Medical complications are potential barriers to optimal recovery after acute ischemic stroke. Hypotension and shock can be particularly deleterious to the recovery of the penumbral tissue. The frequency of shock in patients admitted with acute stroke has not been systematically evaluated. We assessed the hypothesis that shock is not uncommon after ischemic stroke and is related to clinical prognosis.Methods: We evaluated a prospectively collected database of consecutive patients admitted to a tertiary hospital with acute ischemic stroke from January 2010 to December 2015. Shock was defined as persisting hypotension requiring vasopressors to maintain mean arterial pressure ≥65 mmHg.Results: A total of 1145 patients (mean age 72 +/-16 years, 56% males) were evaluated. Shock was diagnosed in 15 patients (1.3%). These patients were similar in age, gender, blood pressure at hospital admission, and previous history of coronary artery disease to patients without shock. Sepsis was the most common single etiology of the shock (93%). Septic source was pulmonary in 60%, abdominal in 13%, undetermined in 20% and blood borne in 6.6%. Septic shock was diagnosed at a median of 14 days [8,20] after hospital admission. Patients who developed shock had a higher National Institutes of Health Stroke Scale (NIHSS) at admission (12 [8,20] vs 3 [1,10], p<0.01), a higher frequency of diabetes (60% vs 30%, p=0.01), urinary tract infection (27% vs 4.8%, p<0.01), pneumonia (47% versus 4.5%, p<0.01), acute renal (33% vs 0.7%, p<0.01) and respiratory (53% vs 1.8%, p<0.01) failures. Length of hospital stay (39 [29,156] vs 8 days [4, 15], p<0.01) and ICU stay (19[7, 27.5] vs 0 days [0,3], p<0.01) were higher in patients with shock. Shock was associated with a hospital mortality of 80% vs 9% in patients without shock (p<0.01). In multivariate logistic regression analysis, only pneumonia (OR: 16.9, [4.1-69.4],p<0.01) and NIHSS 1.07 [1.01-1.15, p=0.04] at admission were predictors of developing shock during hospital admission.Conclusion: In conclusion, shock was an infrequent but severe complication in patients with stroke and was associated with a very high mortality. Sepsis was the most important etiology.