Objective:To investigate the correlation between right-to-left shunt (RLS) and lesion pattern on diffusion-weighted imaging (WDI) in young patients with cryptogenic stroke (CS).Methods:Young patients with CS admitted to the Department of Neurology, Brain Hospital of Hunan Province from January 2017 to June 2020 were selected. According to the results of head MRI, they were divided into multiple infarction group and single infarction group. The demographic characteristics, clinical data, DWI lesion characteristics, RLS and shunt volume were compared between the two groups. Multivariate logistic regression analysis was used to identify the correlation between RLS and shunt volume and lesion pattern on DWI. Results:A total of 90 young patients with CS were enrolled. Among them, 61 (67.8%) were males, and their age was 39.87±3.49 years. There were 44 patients (48.9%) in the multiple infarction group and 46 (51.1%) in the single infarction group. Compared with the single infarction group, the RLS detection rate in the multiple infarction group was significantly higher ( P<0.05), the infarcts were more common in the cortex-subcortex ( P<0.05), and more infarctions were small infarcts ( P<0.05). Multivariate logistic regression analysis showed that cortical-subcortical lesions (odds ratio 6.875, 95% confidence interval 1.917-24.649; P=0.003) and RLS (odds ratio 2.631, 95% confidence interval 1.006-6.879; P=0.049) were independently associated with multiple infarcts in young patients with CS, but RLS shunt volume was not. Conclusions:Young CS patients with RLS are mostly multiple infarctions. RLS is independently associated with multiple infarctions in young CS patients, while RLS shunt is not.