Symptoms of cerebrovascular events differ depending on the hemisphere in which the lesion arises, thereby affecting disease recognition and management. We aimed to establish whether left and right hemispheric strokes are unequally distributed in inpatients. We obtained data from a large hospital-based stroke registry in Germany. 11,328 patients (56%) had left hemispheric events and 8769 (44%) had right-sided lesions (p<0.0001). Age, stroke severity, and time from symptom onset to admission were significantly associated with left hemispheric stroke, suggesting a selection effect. Difficulties in recognition of symptoms due to right hemispheric stroke challenge efforts to optimise stroke management, particularly in the critical early hours of stroke.