Hyperhomocysteinemia is an independent vascular risk factor involved in ischaemic stroke. Aim of this study was to evaluate the prevalence of hyperhomocysteinemia and the role of the metabolic determinants in ischaemic stroke. The study concerned 183 patients in the Department of neurology of the teaching hospital of Lome. The diagnosis of stroke was made on clinical and brain CT scan arguments. The dosage of homocysteinemia was carried out by the immunoenzymatic method (Abbott Diagnostic). Among 183 patients, 111 (61%) had a hyperhomocysteinemia. The total average homocysteinemia was of 22.0 μmol/L. The average homocysteinemia among men was of 22.4 μmol/L (5.2-198.0) and 18.80 μmol/L (4.2-50) among women with a positive correlation (P = 0.049 and 0.01) between homocysteinemia and the age among the men and women. The average homocysteinemia was of 17.2 μmol/L in the large ischaemic stroke; 23.0 μmol/L when associated with lacunes and 32.8 μmol/L when associated with lacunes and leucoaraiosis (p = 0.001). In conclusion, the hospital prevalence of the hyperhomocysteinemia was of 61%. Hyperhomocysteinemia was the second vascular risk factor after arterial hypertension in term of prevalence, probably from nutritional cause.