Introduction. Stroke is one of the leading causes of morbidity and mortality worldwide. Globally, Cerebro-Vascular Accident (CVA) or stroke accounts for about 10% of all deaths, two-thirds of which occur in low income countries. According to the WHO, stroke is a clinical syndrome characterized by rapidly developing clinical symptoms and/or signs of focal and at times global (applied to patients in deep coma and those with subarachnoid hemorrhage) loss of cerebral function with symptoms lasting more than 24 hrs or leading to death, with no apparent cause other than that of vascular origin. Among the stroke subtypes, cerebral ischemia and infarction constitute about 85-90% of the total stroke subtypes in western countries with only about 10– 15% patients with cerebral hemorrhage. Objectives. The objective of this study is to evaluate the clinico – epidemiological profile and clinical presentation of acute stroke in relation to age, sex, as well as, the prevalence of accompanying symptoms and clinical manifestations. Methods. The study was conducted between January 2016 and December 2016 and included 880 subjects of both sexes, aged 30-86 with a diagnosis of stroke. All consecutive cases attending the study site were enrolled and studied with predesigned questionnaires after obtaining ethical clearance for this observational study. Predesigned pretested questionnaire was used to assess demographic profile, behavioral risk factor, all the patients were assessed clinically through detailed history and clinical examination. From the history, various demographic variables were collected including age, sex, history of transient ischemic attack/stroke, hypertension, diabetes mellitus, coronary artery disease, prestroke disability, smoking, and family history of stroke. After the availability of the results of all investigations, ischemic stroke patients were grouped according to the TOAST subtypes. Inclusion criteria: 1. Subjects aged older than 20 years. 2. The diagnosis of acute stroke (ischemic/hemorrhagic) based on clinical evaluation and imaging (computed tomography [CT]-head/magnetic resonance imaging [MRI] brain). Exclusion criteria: 1. Patients with stroke-like conditions due to systemic diseases such as infections and trauma.2. All hemorrhagic stroke patients who have posttraumatic, drug-induced (e.g., anticoagulant-induced), and those with bleeding diathesis-related etiologies will be excluded.3. Patients in whom the whole investigation protocol was not possible. All the data were fed on excel spreadsheet, and statistical analyses were made using Epi Info version 3.3.2. Results. A total of 880 cases of strokes were enrolled, out of 916 CVA and the response rate is 96%. The age of the participants ranges from 30-92 years with an average of 68.3 ± 17.7 years. Majority of the study participants 584 (66.36%) were between 50–69 years and presented with ischemic CVA (725 - 82.4%), while 155 (17.6%) had hemorrhagic CVA. Clinical signs and symptoms of ischemic and hemorrhagic CVA showed significant difference in symptoms like change in consciousness (p = 0.001), weakness in face/limb (p = 0.002), dysphagia (p = 0.002), headache (p = 0.002), diabetes (p = 0.001), tobacco consumption (p = 0.002) and alcohol consumption (p = 0.001). During occurrence of current event symptoms occurs at home in 82.6% while 8.9% were in workplace and 8.5% other places. Ambulance services were availed by 89.6% of the sufferers for transportation, while 10.4% travelled by privately hired vehicle. Thus, using TOAST classification, it was observed that 381cases (43.6%) had large vessel atherothrombotic disease, 188 cases (21.4%) had small vessel disease (lacunar infarcts), 117cases (13.4%) had cardioembolic strokes, and 194 cases (22.04%) had stroke of undetermined etiology Among ischemic stroke patients, 464 (64.2%) patients were hypertensive, 180 (23.44%) patients were diabetic, and 309 (42.7%) patients were smokers. Conclusions. Stroke is an important cause of morbidity and mortality and has an increasing trend in the Emergency Medical Services Ischemic CVA constitutes a larger percentage of stroke subtypes 82 4% and using TOAST classification, it was observed that 381cases (43.6%) had large vessel atherothrombotic disease, 188 cases (21.4%) had small vessel disease (lacunar infarcts), 117cases (13.4%) had cardioembolic strokes, and 194 cases (22.04%) had stroke of undetermined etiology Among ischemic stroke patients, 464 (64.2%) patients were hypertensive, 180 (23.44%) patients were diabetic, and 309 (42.7%) patients were smokers.