Fifty-three patients with acute cerebral infarction were treated in a double-blind study with either dexamethasone or placebo within 24 hours of the onset of stroke. Forty-one of these survived for longer than 28 days, and the patients treated with the steroid fared slightly worse than those treated with placebo at the end of this time. Two of the five patients who died in the placebo group died of cerebral edema, compared with three out of seven patients who died in the steroid group. Infectious complications, gastrointestinal hemorrhage, and occasional serious exacerbations of diabetes occurred more commonly in the steroid group.