Could you please post your INI ?
SkyrimPrefs.ini
Spoiler [Display]iMultiSample=1iWaterMultisamples=1bTransparencyMultisampling=0iMaxDecalsPerFrame=100iTexMipMapSkip=0iTexMipMapMinimum=0fDecalLOD1=500.0000fDecalLOD2=1000.0000iActorShadowCountInt=0iActorShadowCountExt=0fSpecularLODStartFade=0.0000fShadowLODStartFade=0.0000fLightLODStartFade=0.0000bDrawShadows=0iShadowFilter=0iShadowMapResolution=1fShadowBiasScale=0.0000fInteriorShadowDistance=0.0000fShadowDistance=0.0000iBlurDeferredShadowMask=0bFloatPointRenderTarget=0iShadowMaskQuarter=0bFXAAEnabled=0fGamma=1.0000iShadowMode=3bTreesReceiveShadows=0bDrawLandShadows=0bFull Screen=1iSize H=240iSize W=320fLeafAnimDampenDistEnd=0.0000fLeafAnimDampenDistStart=0.0000fTreesMidLODSwitchDist=0.0000fMeshLODFadePercentDefault=0.0000fMeshLODFadeBoundDefault=0.0000fMeshLODLevel2FadeTreeDistance=500.0000fMeshLODLevel1FadeTreeDistance=1000.0000fMeshLODLevel2FadeDist=1000.0000fMeshLODLevel1FadeDist=1500.0000iScreenShotIndex=0bShadowMaskZPrepass=0bMainZPrepass=0iMaxSkinDecalsPerFrame=0iMaxAnisotropy=1sD3DDevice="Royal BNA Driver"[LOD]fLODFadeOutMultActors=7.2000fLODFadeOutMultObjects=2.4000fLODFadeOutMultItems=1.0000fLODFadeOutMultSkyCell=1.0000[TerrainManager]fTreeLoadDistance=0.0000fBlockLoadDistanceLow=500.0000fBlockLoadDistance=1000.0000fSplitDistanceMult=0.2500fHighBlockLoadDistanceLow=500.0000fBlockMaximumDistance=0.0000fBlockLevel1Distance=500.0000fBlockLevel0Distance=250.0000bShowLODInEditor=0[Grass]b30GrassVS=0fGrassStartFadeDistance=400.0000fGrassMaxStartFadeDistance=7000.0000fGrassMinStartFadeDistance=400.0000[Imagespace]bDoDepthOfField=0iRadialBlurLevel=0[Water]bUseWaterRefractions=0bUseWaterReflections=0bUseWaterReflectionBlur=0bUseWaterDisplacements=0bUseWaterDepth=0iWaterReflectWidth=128iWaterReflectHeight=128bReflectExplosions=0iWaterBlurAmount=0bAutoWaterSilhouetteReflections=0bForceHighDetailReflections=0[BlurShaderHDR]bDoHighDynamicRange=0[MAIN]fSkyCellRefFadeDistance=0.0000bGamepadEnable=0bCrosshairEnabled=1fHUDOpacity=1.0000bSaveOnPause=0bSaveOnTravel=1bSaveOnWait=1bSaveOnRest=1[GamePlay]bShowFloatingQuestMarkers=1bShowQuestMarkers=1iDifficulty=1[Interface]bDialogueSubtitles=1bGeneralSubtitles=1bShowCompass=0[Controls]fMouseHeadingSensitivity=0.0500fGamepadHeadingSensitivity=3.5500bAlwaysRunByDefault=1bInvertYValues=0bGamePadRumble=1bMouseAcceleration=0[Particles]iMaxDesired=0[SaveGame]fAutosaveEveryXMins=60.0000[AudioMenu]fAudioMasterVolume=1.0000fVal7=1.0000uID7=0fVal6=1.0000uID6=0fVal5=1.0000uID5=0fVal4=1.0000uID4=0fVal3=0.6000uID3=466532fVal2=1.0000uID2=554685fVal1=1.0000uID1=1007612fVal0=1.0000uID0=94881[Clouds]fCloudLevel2Distance=0.0000fCloudLevel1Distance=0.0000fCloudLevel0Distance=0.0000fCloudNearFadeDistance=0.0000[General]iStoryManagerLoggingEvent=-1bEnableStoryManagerLogging=0[Trees]bRenderSkinnedTrees=0uiMaxSkinnedTreesToRender=0[Decals]uMaxDecals=1000bDecals=1bSkinnedDecals=1uMaxSkinDecals=100uMaxSkinDecalsPerActor=60
Skyrim.ini
Spoiler [Display]sD3DDevice="Royal BNA Driver"iPresentInterval=0[Grass]b30GrassVS=0[Water]bReflectLODObjects=0bReflectLODLand=0bReflectSky=0bReflectLODTrees=0[General]sLanguage=ENGLISHuGridsToLoad=1uInterior Cell Buffer=1uExterior Cell Buffer=12[BlurShaderHDR]bDoHighDynamicRange=0[MapMenu]bWorldMapNoSkyDepthBlur=1[Imagespace]bDoRadialBlur=0[Interface]fNoteDistance=70.0000fBookDistance=90.0000fBookPosWidthPercentage=0.5000fBookPosHeightPercentage=0.5000[LOD]fLODLandDropAmount=200.0000fLodDistance=300.0000[Menu]iConsoleTextSize=10iConsoleSizeScreenPercent=90
there's a lot of weird hacks that i don't entirely understand that mostly just involved finding big numbers and making them little numbers and also setting a bunch of things to 0. some stuff is specifically geared towards my running at 320x240, like the book/note FOV and the console text size. also i'm sure like 80% of those values don't actually do anything and only serve as a placebo.
i also just took a bunch of screenshots in/around Whiterun at 800x600 to sort of show off how those settings look at the kind of resolution a normal person would play at.
http://localhostr.com/file/bYUXKZ0/2011-11-22_00015.jpg
http://localhostr.com/file/lLmKaHT/2011-11-22_00016.jpg
http://localhostr.com/file/qYfw1NL/2011-11-22_00018.jpg
http://localhostr.com/file/9KoHQz9/2011-11-22_00019.jpg
http://localhostr.com/file/LUu44DM/2011-11-22_00020.jpg
http://localhostr.com/file/uUI0nBN/2011-11-22_00021.jpg
http://localhostr.com/file/CJ6sZcq/2011-11-22_00022.jpg
these last two show off what i THINK is going on - the game never loads the full-quality mesh, only LOD meshes. this is good because the full meshes would probably wreck my [censored], but it leads to some oddities like this (though if you're playing at 320x240 immersion doesn't count for much anway)
http://localhostr.com/file/k2ciEXQ/2011-11-22_00023.jpg
http://localhostr.com/file/mUHAutx/2011-11-22_00025.jpg
i never went above 15fps in any of these, and Whiterun is one of the best areas in the game for me performance-wise, so if you're thinking of using them yourself and you've got similar specs keep that in mind. 640x480 runs pretty poorly too but is generally sort of playable. 320x240 runs great but looks like a DS game.