Introduction - Strokes represent a major public health problem exacerbated by an aging population. The existence in Dijon of the only French population-based registry dedicated to strokes has made it possible, for the first time, to study trends in stroke incidence over a 20-year period. Methods - From 1985 to 2004, the registry collected all new cases of stroke occurring in patients residing in the city of Dijon (population 150,000), regardless of the care setting, using WHO clinical criteria and brain imaging data to ensure the specificity of the data collection. The participation of hospital and private practice physicians in the city and suburbs of Dijon ensured high completeness. Results - Between 1985 and 2004, 3,122 new cases of stroke (1,493 in men and 1,629 in women) were recorded. The mean age at onset was 71.4 years for men and 76.5 years for women. No significant variation in age-standardized overall incidence rates was observed among men and women. However, analysis of temporal trends by subtype showed contrasting patterns, illustrated by a significant decrease (p = 0.01) in the incidence rates of cardioembolic strokes and a significant increase (p = 0.01) in lacunar strokes. Conclusion - Overall, stroke incidence rates remained stable between 1985 and 2004. The observed trend of increasing lacunar strokes versus decreasing thromboembolic strokes warrants further research to better understand its causes. (R.A.)