Background: The prognostic factors for patients presented with acute cerebrovascular strokes, based upon MRI diffusion-perfusion mismatch, size of stroke and pre morbid risk factors to predict the outcome of the patients. Objective: Assessment of cerebral infarction outcome through clinical and imaging study by using diffusion-weighted imaging and perfusion MRI.  Patients and Methods: Patients admitted in Neurology Department of Al-Azhar University Hospitals (Al-Hussein and Sayed Galal Hospitals), during the study period from 1/12/2015 to 30/7/2016, with diagnosis of acute cerebrovascular stroke. All patients were subjected to clinical assessment by NIHSS score at time of admission, radiologic assessment (infarction volume by MRI diffusion, MRI diffusion perfusion mismatch), and reevaluation after 1.5 months. Data were collected and analyzed by SPSS program, using t-test, chi square and ANOVA. Results: The patients were classified into two groups: Group I: (26 patients) have good outcome, and Group II:  (14 patients) have poor outcome according to clinical assessment by NIHSS score at time of admission and infarction size in MRI diffusion. The most predictive factors of patients with acute ischemic stroke outcome were history of uncontrolled diabetes, smoking, site of infarction, infarction volume by MRI diffusion, MRI diffusion perfusion mismatch and follow up radiology after one and half months the most significant statistical difference. Conclusion: Control of diabetes, smoking cessation and other metabolic factors improved the outcome of patients with acute ischemic stroke. Radiological assessment of acute ischemic stroke patients by infarction size in MRI diffusion   and degree of diffusion perfusion mismatch were mandatory for better assessment of the stroke severity and prediction of outcome.