Background: Although stroke mortality in developing countries is more than 85%, the case fatality in Uganda is not known. Objective: We determined 30 day case fatality, associated clinical and laboratory presentations among adult stroke patients admitted to Mulago Hospital. Design: Prospective descriptive study. Setting: Mulago national referral hospital, Kampala, Uganda. Participants: Stroke patients presenting from July 2010 to January 2011. Intervention Patients presenting to the accident and emergency with stroke confirmed on brain computerised tomography (CT) scan were recruited consecutively and subsequently transferred to the neurology unit. Selected social demographics, clinical and laboratory presentations were obtained. Supportive care, specific treatment and rehabilitation services were offered to the participants. Main Outcome Measures: Case fatality rate at 30 days Results: Out of 150 eligible participants, 17 declined, 133 were enrolled into the study but 5 were lost to follow up. Data from 128 participants were analysed. The mean age was 62.3+15.7 years and 58.0% were females. Ischemic and haemorrhagic stroke contributed 79% and 21% respectively. Majority of participants 97 (76%) had only motor deficits and 78 (61%) had impaired consciousness. More than half of participants had high blood pressure at admission, with diastolic and systolic hypertension among 106 (83%) and 68 (53%)respectively. Forty eight (38%) participants had hyperglycemia, 42 (33%) leucocytosis, 13% elevated low density lipoprotein and 9% high triglycerides. No participant with ischemic stroke presented in time for thrombolysis. The 30 day case fatality was 43.8% and factors independently associated with it were Glasgow coma scale (GCS) < 9 p = 0.001and age 51-60 years P=0.044. Conclusion: Thirty-day case fatality was high. Poor prognostic factors were GCS of <9 and age 51-60 years. Early presentation to hospital, intensive management, implementation of treatment guidelines and measures to prevent stroke should be emphasised.