Abstract: Homocysteine, as an independent risk factor for stroke, is closely related to the incidence, recurrence rate and prognosis of stroke. Homocysteine level varies in different stroke subtypes, and the pathogenesis mainly involves vascular endothelial injury, hyperplasia of smooth muscle cells, coagulopathy, and abnormal fat metabolism. Homocysteine level is affected by genotype, metabolism, age, gender, drugs and other factors. Supplementation with B vitamins and folic acid can significantly reduce homocysteine level, which is important for secondary prevention of cerebrovascular disease. In this study, the correlation between homocysteine level and stroke, subtype and severity, and the role of homocysteine in the pathogenesis of stroke, and the treatment status were reviewed to provide references for clinical prevention and treatment.