Cerebrovascular accidents are the third leading cause of death after myocardial infarction and cancer in all Western societies. A more complete understanding of the pathogenetic determinants of stroke is required in order to achieve a better prevention and treatment of this common disease. Recently, based on convincing epidemiological and experimental evidence, the concept of stroke as a complex, multifactorial, polygenic disease has been well assessed. Thus, together with known modifiable determinants, such as smoking, obesity, hypertension, cardiac diseases and diabetes, specific hereditary factors for stroke are now taken into account when analysing the pathogenesis of cerebrovascular accidents. In particular, there have recently been important findings related to the genetic basis of stroke in suitable animal models and in humans, thus representing the promise of a more thorough understanding of the pathogenesis of stroke in the future and of a more specific preventive and therapeutic approach to this common pathological condition.