Introduction: Acute ischemic stroke (AIS) is a significant cause of morbidity and mortality, particularly in developing countries. It can involve either the anterior circulation (ACS) or the posterior circulation (PCS), each with distinct clinical and radiological profiles. This study aims to analyze and compare the clinical presentations and radiological profiles of patients with ACS and PCS. Methods: This observational study was conducted at PES Institute of Medical Sciences and Research, Kuppam, from January 2021 to June 2022. Ninety-seven patients with acute ischemic stroke confirmed by neuroimaging were included. The clinical features were correlated with neuroimaging findings. Results: Out of 97 patients, 69.1% had ACS, and 30.9% had PCS. ACS was more prevalent in males (64.6%), while PCS showed a higher incidence of cerebellar signs, ataxia, giddiness, and visual disturbances. Hypertension was a predominant risk factor for both ACS and PCS, with a higher prevalence in PCS patients (82.1%). Conclusion: Distinct clinical features, such as headache, visual disturbances, and ataxia, were more prevalent in PCS. Accurate clinical diagnosis, supported by neuroimaging, remains crucial for effective stroke management.