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.