Introduction: Hemorrhagic stroke is a major cause of death and disability in low-resource settings. The objective of this study was to describe the epidemiological, clinical, therapeutic, and prognostic features of hemorrhagic stroke patients managed in the Emergency Department (ED). Methods: We conducted a prospective descriptive and analytical study in the ED of CHU Gabriel Touré over a 12-month period. We included all patients presenting with a focal neurological deficit without head trauma and with CT-confirmed hemorrhagic stroke. Data were collected using a standardized form and analyzed with SPSS version 22. Categorical variables were compared using the chi-square test or Fisher’s exact test as appropriate, and relative risks were calculated. Statistical significance was set at p < 0.05. Results: Among 751 stroke cases, 224 hemorrhagic strokes were recorded, accounting for 29.8% of all strokes. The mean age was 53.7 years, with a male predominance (62%). Hypertension was the main risk factor (77.4%). The most frequent reasons for admission were motor deficit (79.3%) and altered level of consciousness (73%), with abrupt onset in 91.1% of cases and admission within 6 hours in 65.2%. CT imaging showed intracerebral (intraparenchymal) hemorrhage in 60.7% of patients. Intensive supportive care was common (intubation 45.5%, oxygen therapy 78.1%), and 18.8% underwent neurosurgical management. The leading complications were aspiration pneumonia (76.9%) and intracranial hypertension (50.8%). In-hospital mortality was 44.6% and was significantly associated with severe prognostic scores (ICH ≥ 3), impaired consciousness, intracranial hypertension, ventilator-associated pneumonia, and malaria. Conclusion: Hemorrhagic stroke affected predominantly relatively young adults and was associated with high in-hospital mortality. Strengthening hypertension prevention and control, reducing pre-hospital delays, and improving access to intensive and neurovascular care are essential t