Facial skin temperature depends strongly on blood flow in small blood vessels in the skin. These are regulated by the sympathetic part of the autonomic nervous system. Delirium may pathophysiologically be associated to changes in the sympathetic part of the autonomic nervous system. In this observational study, we evaluated the influence of various exogenous and endogenous covariables on the regional facial temperatures in acute stroke patients with and without delirium. Facial thermography (FT) was performed using an infrared digital camera. Screening for delirium was done using the Confusion Assessment Method (CAM). Sixty-four patients were enrolled. Eight patients developed delirium. Sex and body temperature were positively associated to facial skin temperature, and so was ambient temperature but to an overall lesser magnitude. Stroke severity, diabetes, infection, facial palsy, facial sensory deficit, and physical activity did not influence facial skin temperature. Overall, there was no association between facial temperature and the occurrence of delirium except in one facial region, the medial palpebral commissure.