OBJECTIVES: Stroke is the second leading cause of death worldwide and a major cause of long-term disability. Increasingly, stroke outcomes research is following clinical practice and not only considers all strokes together but divides them into various risk-profile subtypes. Following this approach, we performed a population-based study of all residents of Erlangen, Bavaria, Germany, to determine the risk profile distributions in a well-defined population and their long-term impact on disability and patterns of care. METHODS: Since 2000 the Erlangen Stroke Project (ESPro) is the reporting centre for stroke for the German Federal Government. As the only population-based stroke registry in Germany ESPro is recording each patient living in Erlangen, Bavaria, Germany (source population 100,500) who suffered from stroke. The patients were analysed at time points after admission as well as 3 and 12 month after the event. A total of 1355 patients with a first-stroke were registered in the ESPro. The cause of ischemic stroke was classified according to the TOAST criteria. Etiological TOAST classification was performed in 89% (1206) of ischemic strokes. RESULTS: The etiological classification of brain infarctions resulted in 12% large-artery atherosclerosis, 26% cardioembolism, 24% small-artery occlusion, 37% strokes of undetermined etiology and 2% strokes of other determined etiology. While 20% of the patients were independent functionally at the Barthel index at admission, the number was 39% after 12 month. The category large-artery atherosclerosis showed the strongest relationship with the occurring need of care. The OR with very strong care needs 12.79 (95% CI3.71 –44.07) lay particularly high in comparison with an OR of 6.95 (95% CI 2.16 – 22.33) in the category cardioembolism. CONCLUSIONS: The TOAST classification provides an appropriate tool for estimating the need of care. In particular the patients in the TOAST category large-artery atherosclerosis showed a high level of a need of care at the long-term follow-up.