Background: Stress response after stroke can increase levels of cortisol and catecholamine’s.This cortisol response to stroke is identified in both cerebral infarction as well as ICH. High Serum cortisol level have been related to the severity and adverse clinical and functional outcome in stroke. The correlation of Serum cortisol and severity of stroke in not well studied in the ruralpopulation Aim:1.To investigate if a single Serum cortisol level determination could predict the outcome of stroke.2.Whether Serum cortisol as well as stroke severity is related to any clinical or paraclinical parameters of known relevance in acute stroke.3.To gain knowledge of the level of correlation between various clinical and paraclincal parameters with serum cortisol and stroke severity.Materials and methods 65 patients admitted with acute stroke within 24 hours of onset. Patient recruited from medical wards and IMCU ofTirunelveli medical college hospital. Study design:Cross sectional descriptive study. Study period :January2017 to January 2018..A diagnosis of cerebral infarction or an intracerebral haemorrhage based on clinical findings as well as history at the time of admission and with the help of CT scan.Blood samples taken for Total Count, Blood sugar and Serum cortisol levels. Serum cortisol estimated by competitive immune enzymatic colorimetricResults: Out of 50 patients, Mean cortisol level was about 18.43 mg/dl with SD of 9.93mg/dl. Scandinavian stroke scale assessment, which is a measure of severity of stroke ranged from 4 to 50 in our patients for a total of 60 at the of admission with mean of 27.7 and SD of 12.03. Correlation between serum cortisol and scandinavian stroke scale (SSS) score was found to be statistically significant with p value of <0.001.Conclusion:Serum cortisol is a prognostic marker to predict functional outcome and mortality in patients with stroke. This is evidenced by high correlation between serum cortisol and scandinavian stroke scale (SSS) score .SSS score is inversely related to stroke severity i.e., lower the score, higher the severity