Background: Very few population based cohort studies have focused on the long term recurrence of stroke. Objective: To examine 10 year c umulative recurrence rates for stroke in a Japanese cohort according to patholog ical type and clinical subtype of brain infarction. Methods: During a 32 year fo llowup of 1621 subjects ≥40 years of age, 410 developed first ever stroke.These were followed up prospectively for 10 years after stroke onset. Results: During follow up, 108 (26%) experienced recurrent stroke. The cumulative recurrence r ates were 35.3%atfive years and 51.3%at 10 years. The 10 year recurrence rates of subarachnoid haemorrhage (SAH), brain haemorrhage, and brain infarction were 70.0%, 55.6%, and 49.7%, respectively;the difference between SAH and brain i nfarction was significant (p = 0.004). Most recurrent episodes after SAH or brai n haemorrhage happened within a year after the index stroke, whereas recurrence of brain infarction increased consistently throughout the observation period. Ca rdioembolic stroke had a higher recurrence rate (75.2%) than lacunar infarction (46.8%) (p =0.049). The 10 year risk of stroke recurrence increased with age a fter lacunar or atherothrombotic brain infarction, but not after the other types or subtypes. After atherothrombotic brain infarction, cardioembolic stroke, or SAH, the type and subtype of most recurrent strokes were the same as for the ind ex stroke,but recurrence after lacunar infarction or brain haemorrhage showed di vergent patterns. Conclusions: Japanese people have higher recurrence rates of s troke than other populations. Recurrence rate after a first brain infarct increa ses consistently through the next 10 years. Background: Very few population based cohort studies have focused on the long term recurrence of stroke. Objective: To examine 10 year c umulative recurrence rates for stroke in a Japanese cohort according to pathological type and clinical subtype of brain infarction. Methods: During a 32 years fo llowup of 1621 subjects ≥ 40 years of age, 410 developed first ever stroke. These were followed up prospectively for 10 years after stroke onset. Results: During follow up, 108 (26%) experienced recurrent stroke. The 10 year recurrence rates of subarachnoid haemorrhage (SAH), brain haemorrhage, and brain infarction were 70.0%, 55.6%, and 49.7%, respectively; the difference between SAH and brain Most recurrent episodes after SAH or brai n haemorrhage happened within a year after the index stroke, post recurrence of brain infarction were consistently throughout the observers The 10-year risk of stroke recurrence increased with age a fter lacunar or atherothrombotic brain infarction, but not after the period (r = 0.58) was higher than that of lacunar infarction (46.8%) other types or subtypes. After atherothrombotic brain infarction, cardioembolic stroke, or SAH, the type and subtype of most recurrent strokes were the same as for the ind ex stroke, but recurrence after lacunar infarction or brain haemorrhage showed di vergent patterns. Conclusions: Japanese people have higher recurrence rates of s troke than other populations. Recurrence rate after a first brain infarct increa ses consistently through the next 10 years.