BackgroundAcute stroke management is well-established in developed countries with no gender difference. Yet, in developing countries there are reports on gender disparity in medical services including stroke services. Egypt, a developing low–middle-income country, heavily populated, in the Middle East is a good example to answer whether acute ischemic stroke service is provided equally to males and females or there is disparity in risk factors, onset to door (OTD), door to needle (DTN), and outcome. The current study was prospective observational analytical hospital-based study, on acute ischemic stroke cases admitted to Nasr city insurance hospital stroke unit between September 2020 and September 2022.Results350 cases were included, 257 males and 93 females. Hypertension was the commonest risk factor 66% males and 81% femalesP= 0.011, atrial fibrillation was predominant in femalesP< 0.001, smoking was predominant in malesP< 0.001. Median OTD in hours was 8.0 among both genders with minimum zero and maximum 96 h in males compared to minimum 1 and maximum 120 h in females, DTN was around 30 min with no significant difference. Median NIHSS on which rtPA was administered was 12.5 (6–13) in females compared to 10 (6–12) in males. Males who did not receive rtPA had a better mRS on discharge and on 90 daysP= 0.01, 0.009, respectively, while there was no significant difference on discharge and 90 days between both genders on receiving rtPA.ConclusionsNo gender disparity was found in DTN, discharge outcome, and 90 days among rtPA recipients. Females tended to have higher NIHSS and relatively delayed presentation to ER with less favorable outcome at discharge and 90 days in case of not receiving rtPA. Encouraging earlier arrival and conducting awareness campaigns for risk factors management is warranted.