Introduction: Cerebrovascular diseases are important causes of disability and death. Cardiovascular diseases and stroke share most of the risk factors and there is an intense relation between cerebral and cardiac homeostasis. Electrocardiogram can be used as measurement of neurogenic cardiac abnormalities as it has been suggested that lesions in the insula may result in abnormal electrocardiographic (ECG) findings and increased risk of sudden death. We assessed the hypothesis that electrocardiographic changes in acute stroke could predict neurological outcome at 90 days Methods: It was a longitudinal prospective study, with stroke patients admitted in an acute Stroke Unit from March 2012 to March 2013. We included all stroke patients within 24h of symptom onset and diagnosis confirmed with head CT scans. We excluded patients with history of cardiac surgery, myocardial infarct and pulmonary thromboembolism within 2 weeks before stroke. We collect data about clinical history and demography, admission NIHSS score and ECG. All patients were followed and in hospital complications, length of stay and modified Rankin score at 90 days were registered. Follow up visits were done by a Neurologist blinded to admission ECG findings; and ECG were analyzed by a Cardiologist blinded to clinical aspects. Statistical analysis was done with logistic regression with correction to gender, admission NIHSS, presence of clinical complications and blood pressure control. Results: Of 247 admitted to stroke unit, 112 fulfilled inclusion criteria and agreed to participate. It was observed positive correlation between ST segment abnormalities on admission ECG and cardiac complications during hospitalization (OR 4.73, IC(95%) 1.49 - 14.98, p: 0.008), worse neurologic outcome at 90 days measured by Rankin 3 - 6 (OR 3.4, IC(95%) 1.07-11.12, p: 0.038), and death at the end of follow up (OR 4.25, IC(95%) 1.17-15.49, p: 0.028). Conclusions: In conclusion, this study showed that ECG findings at admission, especially ST segment abnormalities, were correlated to higher chance of in hospital cardiac complications, worse neurologic outcomes and mortality at 90 days.