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Stroke is the second leading cause of death in Sub-Saharan Africa (SSA), 1 with evidence suggesting that incidence is increasing over time. 2 However, epidemiological studies of stroke in SSA are limited in number and quality, 3 and there are large gaps in our understanding of the natural history of stroke in SSA. 4 Stroke is preventable, and 90% of stroke burden globally is attributable to modifiable risk factors. 5 However, these risk factors differ by ethnicity, geographical location, socioeconomic status and access to health care. 6, 7 The Stroke in Sierra Leone (SISLE) register is a prospective observational stroke register established to determine the prevalence of stroke risk factors, stroke phenotypes, patient pathways to care, quality of hospital care and outcomes after stroke in Sierra Leone. Stroke registers provide the data to estimate burden of disease, drive quality improvement 8, 9 and assess stroke systems …