The article presents an overview of the problem of respiratory failure in patients with acute stroke, its prevalence, leading pathophysiological factors, clinical features, and diagnostic methods. Stroke is the third leading cause of death worldwide. Stroke survivors often experience medical complications that may be the direct cause of mortality. The syndrome of respiratory failure and respiratory complication are common after stroke. The syndrome of respiratory failure syndrome of varying severity is following after stroke in 44 – 90%, often remains undervalued, undiagnosed, due to the clinical features of this category of patients. The nature of these disorders depends on the severity and site of neurological injury. Abnormality of breathing control, respiratory mechanics, and breathing pattern are common and may lead to gas exchange abnormalities or the need for respiratory support. The leading symptom is hypoxemia, which is often hidden, and may be detected by examining of arterial blood gasses (PaO2, PCO2). Stroke can lead to sleep disordered breathing such as central or obstructive sleep apnea. Sleep disordered breathing may also play a role in the pathogenesis of cerebral infarction. Venous thromboembolism, swallowing abnormalities, aspiration, and pneumonia are among the most common respiratory complications of stroke. Neurogenic pulmonary edema occurs less often but may be very dramatic. Therefore, early diagnosis, prevention and treatment are important in reducing mortality and improving functional rehabilitation.