Introduction Stroke is the second most common cause of adult death in Africa. We report the characteristics of stroke in Freetown, Sierra Leone. Methods A prospective observational register recorded all patients 18 years and over with stroke between May 2019 and April 2020. Stroke was defined according to the WHO criteria. Pearson’s chi squared test was used to examine associations between categorical variables and unpaired t-tests for continuous variables. Multivariable logistic regression was performed to explain in-hospital death, we report odds ratios (OR) and 95% confidence intervals. Results 385 strokes were registered, 315 (81.8%) were first in a lifetime events. Mean age was 59.2 (SD 13.8) and 187 (48.6%) were male. 327 (84.9%) of strokes were confirmed by CT scan. 231 (60.0%) were ischaemic, 85 (22.1%) intracerebral haemorrhage, 11 (2.9%) subarachnoid haemorrhage and 58 (15.1%) undetermined stroke type. The median Barthel Index before stroke was 100 (IQR 100-100) and median