Objective To analyze the consistency of perceived risk and actual risk of recurrent stroke in young and middle-aged patients, to explore the influencing factors, and to provide reference for enhancing accuracy of perceptions and reducing stroke recurrence.Methods A total of 337 young and middle-aged stroke patients were invited to complete a battery of questionnaires including a self-designed demographic questionnaire, the Essen Stroke Risk Score, Perceived Risk of Stroke Recurrence, short form of the Fear of Progression Questionnaire, Self-perceived Burden Scale, Social Support Rating Scale, and Modified Barthel Index Scale.Results Among 337 participants, 100（29.7%） underestimated, 173（51.3%） accurately estimated, and 64（19.0%） overestimated their risk, with the kappa coefficient of 0.110 （P＜0.05）.Multinomial logistic regression analysis showed that age, education level, fear of disease progression, and social support were factors associated with the underestimation of recurrent risk, whereas fear of disease progression, Barthel index, and self-perceived burden were factors affecting overestimation of recurrent risk （all P＜0.05）.Conclusion The level of agreement between perceived and actual risk of recurrent stroke in young and middle-aged patients is low.There is a need to focus on young patients and those with lower education level, enhance social support, improve self-care ability, and alleviate self-perceived burden, thereby enhancing the accuracy of their recurrent risk perception.This, in turn, promotes the adoption of healthy behaviors and reduces the risk of recurrence.