The great French organist and composer Louis Vierne (1870-1937) died while performing an organ recital at Notre Dame cathedral in Paris - right in front of the console. This historical article provides insights into the biography of a highly talented musician who was challenged by disability and diseases throughout his career. A special focus is placed on the circumstances of Vierne’s remarkable death. Until now, both a primary cerebrovascular event and a "heart attack" are discussed in reference books and encyclopedias as the immanent causes of death. From the perspective of a stroke neurologist, a reappraisal of Vierne’s medical history and the events that happened during his last concert is presented. Copyright (C) 2012 S. Karger AG, Base