The study aimed at investigation of clinical and neurophysiological features of pyramidal syndrome in patients with vascular damage of right- and left hemisphere in stroke. Forty patients with consequences of acute brain circulation damage were studied: 21 of them with right hemi-paresis (RHP) and 19--with left hemi-paresis (LHP). Cliniconeurological analysis, transcranial magnetic stimulation (TMS), evoked abdominal reflexes, movement motor potential method and somatosensory evoked potentials were used for the examination. Pronounced paresis, tone disturbance, Babinsky symptom, other extensor pathological feet signs, Zhukovsky hand reflex, pseudobulbar syndrome, gait disorder were determined more frequently in patients with LHP. Patients with RHP were characterized by more expressed distal hand paresis and pathological bending feet signs. Compared to RHP patients, those with LHP displayed significantly longer central conduction in TMS, increase of latent periods of components N20, P25, N30 of somatosensory evoked potentials and motor potential area reduction. Functional features of brain hemispheres may to play a certain role in pyramid syndrome formation, right hemisphere damage being characterized by more expressed pyramid disturbances. The data obtained allow to differentiate a great brain hemispheres role in descending motor control as to inhibiting and activating pyramid influences and hemisphere interactions.