Background: Stroke is often considered a disease of older people, but an estimated 10% of 
patients with stroke are younger than 45 years. There is an evidence that the incidence of 
ischemic stroke in young adults is rising, although the reasons for that increase are unclear.
Patients and Methods: We studied patients with acute ischemic stroke or transient ischemic 
attack who were admitted in the stroke unit –Neurology department, Kasr-Alainy hospital 
within the first week of acute event. The study was carried out during the period between 
December 2018 and December 2019. Results: Analysis was done for 70 ischemic stroke 
patients from urban and from rural area. Onset to door was shorter in urban. Urban patients 
showed an older age and higher prevalence of hypertension and diabetes (65.9%, 48.6% 
respectively), while rural patients were characterized by female preponderance (51.5%), more 
dyslipidemia, smoking 44.6%, stroke in young 20.5%, atrial fibrillation 23.8% % and 
recurrent stroke 44.3%. Rural cases showed a severer deficit at onset and poorer outcome. 
Conclusion: Vascular risk factors, stroke type, and presentation tend to differ in Egypt 
according to the geographic distribution whether urban or rural. Studying patterns of such 
difference may aid in planning specific targeted preventive and therapeutic strategies for 
stroke in urban and rural Egypt.