Background: Stroke is a leading cause of long-term disability worldwide, with residual motor and balance impairments contributing significantly to poor functional outcomes. The neutrophil-lymphocyte ratio (NLR), an inexpensive marker of systemic inflammation, has been associated with stroke severity and prognosis. However, limited data exist regarding its predictive value for functional outcomes measured with validated tools such as the Berg Balance Scale (BBS) and Manual Function Test (MFT). Objective: To evaluate the association between NLR at admission and functional outcomes of stroke, assessed using BBS and MFT, in patients admitted with acute ischemic stroke at a tertiary care hospital. Methods: This prospective observational study included 120 patients with first-ever acute ischemic stroke. Baseline demographic and clinical details were recorded. NLR was calculated from complete blood counts at admission and categorized as low (<3) or high (≥3). Functional outcomes were assessed using the BBS and MFT at discharge. Statistical analyses included independent t-tests, chi-square tests, correlation analysis, and multivariate regression. Results: Among 120 patients, 55 (45.8%) had high NLR and 65 (54.2%) had low NLR. Patients with high NLR had significantly lower mean BBS scores (22.5 ± 8.4 vs. 37.8 ± 9.2, p < 0.01) and lower MFT scores (40.3 ± 10.6 vs. 56.7 ± 11.1, p < 0.01) compared to the low NLR group. Pearson’s correlation showed a strong negative relationship between NLR and both BBS (r = –0.49, p < 0.001) and MFT (r = –0.52, p < 0.001). Multivariate regression confirmed that NLR was an independent predictor of poor functional outcome after adjusting for confounders. Conclusion: Elevated NLR at admission is independently associated with worse functional outcomes, including impaired balance and manual function, among patients with acute ischemic stroke. Given its simplicity and accessibility, NLR may serve as a useful adjunct to clinical tools for predicting recovery potential and planning rehabilitation strategies in stroke care.