Ischemic stroke in young patients is a relatively rare event. Few studies have examined the long-term prognosis. The aim of this study was to evaluate the long-term outcome to identify clinical, laboratory and radiologic patterns as possible predictors for mortality, recurrence and functional recovery. We prospectively evaluated 94 patients (42 males and 52 females, aged 14-45 years, mean age 35.5 years, SD 8.4) admitted to our Neurological Department, for first acute ischemic stroke. A 48-month follow-up was performed. The patients were classified according to TOAST and Baltimore classification and Bamford criteria. The severity of the neurological deficit on admission was assessed using the NIHSS. The follow-up included a clinical visit, the modified Ranking scale (mRs) score, Barthel index (BI), and magnetic resonance imaging and intra-extracranial vessel Angio MRI. A good functional outcome (mRS 0-1) was found in 74 patients and unfavourable outcome (mRS 2-6) in 20 patients. 16 patients had a recurrent cerebral ischemic event: 5 patients had stroke and 11 patients had TIA. The average incidence annual rate of recurrence was 4.5% and a mortality rate was of 1.06%. Our study does not demonstrate any predictive factor related to clinical outcome. The relevant data of neuroradiological follow-up is the presence of clinically silent lesions in nine patients, considered as a recurrent stroke. To attribute a prognostic role to these lesions, clinical and neuroradiological follow-up needs to be continued.