BACKGROUND The burden of cerebrovascular disease in developing countries is projected to be on the rise. However, data on the current epidemiology of stroke in Africa are sparse. METHODS Using a 3-staged method, we conducted a door-to-door study of stroke in an urban, mixed-income community in Lagos, Nigeria. We used a modification of the WHO protocol in the first stage, a stroke-specific questionnaire in the second stage and neurological examination of all persons screening positive for stroke in the third stage. We also examined an equal number of stroke-negative persons. RESULTS Overall, the crude prevalence rate of stroke in urban Nigeria was 1.14/1,000 (males: 1.51; females: 0.69). The age-adjusted prevalence rates per 1,000 (adjusted to the USA population 2000) in mid-decade strata showed a trend of increasing prevalence with advancing age as follows: 35-44 years = 0.009, 45-54 years = 0.33, 55-64 years = 0.71, 65-74 years = 0.98, 75-84 years = 2.04 and >85 years = 0.74. CONCLUSIONS Stroke prevalence rates in urban Nigeria are lower than those in most developed countries. The lower rates may be related to lower incidence and higher stroke mortality in developing countries.