The costs of acute stroke care, length of hospital stay (LOS), and outcome in patients with cardioembolic stroke or cardioembolic transient ischemic attacks (TIA) were investigated with the aim of estimating the clinical and health-economic impacts of cerebral cardioembolism. The study population consisted of 511 consecutive patients with the diagnosis of ischemic stroke ( n  = 379) or TIA ( n  = 132) treated at the Department of Neurology, Philipps University, Marburg. Cerebral cardioembolism was defined according to the criteria of the Cerebral Embolism Task Force. Clinical status was assessed by means of Barthel index (BI) and modified Rankin Scale. Costs were calculated using a bottom-up approach. All costs (in Euros) were inflated to the 2008 level. Compared to non-cardioembolic stroke ( n  = 278) patients, patients who had suffered cardioembolic stroke ( n  = 101) had more severe clinical deficits on admission (BI 46.3 ± 27.0 vs. 59.3 ± 34.1; P  < 0.01), worse recovery (BI on discharge 59.2 ± 28.9 vs. 73.1 ± 33.4; P  < 0.01), and increased LOS (12.6 ± 5.7 vs. 10.0 ± 7.8 days; P  < 0.01). The latter also required a relatively higher daily resource utilization due to increased expenses for personnel and diagnostics. Mean costs of acute care for patients with cardioembolic stroke € 4890 per patient (95% confidence interval 4460–5200) were significantly higher than those for patients with non-cardioembolic stroke € 3550 (95% confidence interval 3250–3850); P  < 0.01. The clinical and health-economic impact of cardiogenic cerebral embolism on stroke care is considerable. Patients with cardioembolic stroke/TIA are more severely impaired, and they require longer hospital treatment and increased resource utilization. Costs of acute care of cardioembolic stroke/TIA patients may exceed those of non-cardioembolic stroke/TIA by up to 40%.