Background: Stroke is a common neurological disorder that is encountered in most hospitals in both developed and developing countries. This two-year study was designed to show the characteristics of the problem at the King Fahad Hospital, Hofuf, Saudi Arabia. Patients and Method: This was a prospective study of all Saudi stroke patients admitted to the medical wards in the study period. All patients were assessed individually by one of the two available neurologists. Data was collected on pre-designed protocol, and analysis was performed using tables and figures, and EpiInfo ® computer software. Results: The 329 Saudi patients studied fulfilled the criteria for stroke. The male:female ratio of the patients was 1:1, and their ages ranged between 42 and 92 years (mean 62.8±11.1) for males, and between 20 and 100 years (mean 59.6±15.4) for females. The relative frequencies of stroke subtypes were ischemic infarcts (79%), of which 46% were lacunar infarcts, intracerebral hemorrhage (18.8%), and subarachnoid hemorrhage (2.2%). The most common risk factor was concomitant hypertension with diabetes mellitus (40.4%), hypertension alone (24.9%), diabetes alone (11.6%), atrial fibrillation (5.8%), other cardiac factors (5.5%), transient ischemic attack (TIA) and prior stroke (2.1% each), and smoking (1.8%). No risk factor was detected in 5.8% of the patients. The overall inhospital mortality was 10.0%, with a significant male preponderance. Conclusion: This study demonstrated that stroke is a common neurological condition in the Al-Hassa region of the Kingdom. The male:female ratio was dissimilar from that observed in other parts of Saudi Arabia. The study also showed that hypertension with diabetes constituted a potent risk factor. Sickle cell anemia was not found to be a risk factor. The case fatality was low and both the incidence and mortality showed seasonal preference. We believe that there is a need to establish a Stroke Register at the King Fahad Hospital at Hofuf for the Al-Hassa region.