Objective Construction of a nomogram model based on cerebrospinal fluid free fatty acids （FFA） to predict prognosis in patients with acute ischemic stroke （AIS） and impaired consciousness. Methods From June 2019 to December 2022， 132 AIS patients with consciousness disorders admitted to Jinan City People's Hospital were selected as the research subject. According to the Modified Rankin Scale score during outpatient follow-up on the 90th day after discharge， patients were divided into a poor prognosis group （score 4 to 6 points） and a good prognosis group （score 0 to 3 points）， and the clinical data of the two groups of patients were compared. Multivariate Logistic regression was used to analyze the risk factors affecting poor prognosis in AIS patients with consciousness disorders and establish a nomogram model. The diagnostic performance of the nomogram model was evaluated through receiver operating characteristic （ROC） curve， C-index， and calibration curve. Results There were 39 patients in the poor prognosis group and 93 patients in the good prognosis group The age ［（69.12±9.66） vs （60.34±8.27） years］， proportion of hypertension history ［82.1% （32/39） vs 64.5% （60/93）］， time from onset to admission ［（6.87±2.31） vs （4.14±1.21） h］， hypersensitive C-reactive protein ［（8.02±2.27） vs （4.37±1.78）mg/L］， neuron-specific enolase ［（14.28±3.67） vs （10.24±4.03） ng/mL］， and cerebrospinal fluid FFA levels ［（0.39±0.09） vs （0.22±0.07） mol/L］ of the two groups of patients were compared， and the differences were statistically significant （all P ＜ 0.05）. Multivariate Logistic regression analysis showed that elevated cerebrospinal fluid FFA on admission ［OR=1.062， 95%CI （1.034， 1.090）］， increased age ［OR=1.113， 95%CI （1.002， 1.237）］， prolonged time from onset to admission ［OR=3.118， 95%CI （1.413， 6.881）］， and elevated NSE ［OR=1.651， 95%CI （1.122， 2.430）］ were risk factors for poor prognosis in AIS patients with consciousness disorders， and the differences were statistically significant （all P＜0.05）. The area under the curve for predicting poor prognosis in AIS patients with consciousness disorders using the above variables was 0.888， 0.634， 0.786， and 0.798， respectively， and the optimal cut-off values were 0.315 mol/L， 71 years old， 6 h， and 10 ng/mL， respectively. The ROC curve analysis of the nomogram model showed that the C-index was 0.955， and the calibration curve indicated that the model had good discrimination and consistency. Conclusions The cerebrospinal fluid FFA level， serum NSE level， age， and time from onset to admission are closely related to poor prognosis in AIS patients with consciousness disorders. The nomogram model constructed has high diagnostic performance.