Objectives: To investigate the relationship of serum albumin with severity and outcome of stroke in Pakistani population Material and methods: A prospective cross-sectional study was conducted in Medical Units of Khyber Teaching Hospital (KTH), Peshawar, KPK, Pakistan, during a 3-month period from 8th November 2010 to 8th Feb 2011. Patients, who were admitted to hospital for acute attack of stroke, were included in this study. Data regarding serum albumin, lipid profile and cerebrovascular risk factors were collected. Stroke severity was analyzed by NIHSS (National Institutes of Health Stroke Scale) while functional outcomes were evaluated on mRS (modified Rankin Scale). Results: Total 62 stroke-patients’ data were available during the study period, among which 44 patients were included on the basis of inclusion criteria. Hypertension was the most prevalent cerebrovascular risk factor followed by a concurrent heart disease. The mean pre hospitalization NIHSS score of the patient’s with serum albumin below 4.5gm/dl was found to be 17.75 while post hospitalization score was 10.6. For this group, mean pre hospitalization mRS was found to be 4.6 while post hospitalization score was 3.4. These results show that low serum albumin levels were associated with greater stroke severity and poor functional outcomes. Similarly higher serum albumin levels were associated with decreased stroke severity, shorter hospitalization stay and better functional outcomes.