Background. Stroke is an important cause of morbidity and mortality in young adults especially in developing countries. This two-centre prospective study aimed at reviewing the pattern, types, and case fatality of stroke in the young adults in Northwestern part of Nigeria. Methods. Consecutive patients aged 18-40 years admitted to the medical wards of two tertiary hospitals from June 2008 to August 2010 were recruited. Relevant clinical data were obtained from the patients.The survivors were followed up in neurology clinics for 6 months. Results. A total of 71 patients aged 18-40 yrs, (mean age was 31.9 ± 6) comprising 52(73%) males and 19(23%) females were enrolled. Forty two (59.1%) patients had infarctive stroke. The risk factors included hypertension (74.7%) patients, smoking (50.7%), hypercholesterolemia (9.9%), non-hypertensive cardiac diseases (8.5%), HIV (8.5%), diabetes mellitus (4.2%) cocaine and amphetamine (2.8%), and sickle cell disease (2.8%). Only twelve (17%) patients presented within the first 6 hours of onset of stroke. Seventeen (23.9 %) patients died, case fatality in the first 24 and 72 hrs was 4.2% and 19.7%, respectively. Conclusion. Our data suggests that stroke in young adults is not as uncommon as previously suggested. Hypertension, smoking, hypercholesterolemia, cardiac diseases and HIV are the most common risk factors.