The risk of recurrence of stroke in patients with systemic lupus erythematosus (SLE) is much higher than in other stroke patients, and the preventative treatment is influenced by the underlying systemic disease. Microinfarcts and microhemorrhages are seen frequently in autopsy specimens of SLE patients. Asymptomatic microinfarcts are common, and are now diagnosed due to the high sensitivity of MRI. Occlusions of large arteries and major strokes also occur in lupus patients. Atherosclerosis may be more frequent in SLE patients than in the general population. The major causes of stroke in lupus are cardiogenic emboli and hypercoagulable (including hypofibrinolytic) states, and the mainstay of stroke prevention is long-term warfarin, with an international normalized ratio (INR) of approximately 3.0. Although stroke is an important problem in lupus patients, leading to significant morbidity in young patients, SLE is relatively uncommon in young patients presenting with strokes or transient ischemic attacks (TIAs).