BACKGROUND: Neuron-specific enolase (NSE) is released in the cerebrospinal fluid and bloodstream in response to brain damage. Serum NSE levels can be used as a marker of brain nerve cells either in ischemic or hemorrhagic stroke, associated with lesion volume and functional outcome. AIM: The aim of the study was to evaluate the correlation between NSE serum level with lesion volume and functional outcome in acute stroke patients. METHODS: A cross-sectional study was conducted on 29 patients with ischemic stroke and 29 hemorrhagic strokes admitted to Haji Adam General Hospital. All the subjects were assessed with the National Institute of Health Stroke Scale (NIHSS) score, modified Rankin scale (mRS), and assessment of lesion volume. RESULTS: Subjects consist of 27 male (46.4%) and 31 female (53.4%), with mean age of 61.67 ± 12.26 years. The mean serum NSE levels in stroke patients were 19.79 ± 8.88 ng/ml and lesion volume was 25.09 ± 24.52 ml. There was a significant positive correlation of increase in serum NSE levels with infarct volume (r = 0.863 and p < 0.001) and hemorrhagic volume (r = 0.644 and p < 0.001) and clinical outcome assessed by NIHSS score (r = 0.761 and p < 0.001) and mRS score (r = 0.762 and p < 0.001) in ischemic stroke and NIHSS score (r = 0.525 and p = 0.003), and mRS score (r = 0.468 and p = 0.010) in hemorrhagic stroke. CONCLUSION: High NSE serum levels in the acute phase were associated with lesion volume and poor outcomes in stroke patients.