LEON TROTSKY WAS one of the founders of the Soviet Union and an obvious candidate to replace Lenin after his death. Unfortunately for him, it was Joseph Stalin who came to power, and Trotsky went into a long forced exile that eventually took him to Mexico, where he found asylum. On August 20, 1940, a Stalinist agent wounded Trotsky in the head with an ice axe in his house in Coyoacán, Mexico. Just a few hours later, Mexican neurosurgeons operated on him at the Cruz Verde Hospital in Mexico City. The axe had broken Trotsky's parietal bone and, after tearing the meninges, had damaged the encephalon. Despite the care provided by physicians and nurses, Trotsky passed away 25 hours after he was attacked, a victim of bleeding and shock. This article presents a review of Trotsky's last day, with special emphasis on the doctors who performed the surgery and who took care of the Russian revolutionary in his final moments. The results of Trotsky's autopsy are also discussed. The assassination of Leon Trotsky is one of the most dramatic events of the first half of the 20th century to have taken place on Mexican soil, and those final hours are an important moment in the history of Mexican neurosurgery and in the history of the world.