In this survey we reviewed some of the most recent laboratory and clinical studies on cerebral ischemia in young patients with antiphospholipid antibodies (aPLs). A strong association between aPLs and cerebrovascular ischemic disease has been documented, but the underlying pathogenetic mechanism remains unclear. Furthermore, long-term prognosis is not clear since too few controlled longitudinal studies had been reported. Further prospective clinical trials are needed to define risk factors, to identify different subgroups of patients, and to lead to an effective therapy.