We aimed to investigate the clinical features of Takayasu arteritis (TA) with cerebral infarction (CI) and the risk factors for CI. The study analysed 122 consecutive patients with TA retrospectively. The clinical characteristics of TA patients with and without CI were compared. Binary logistic regression analysis was performed to determine risk factors for CI in TA patients. CI was present in 42 (34.4%) of 122 patients with TA. There were 33 patients with ischemic stroke and 11 with asymptomatic lacunar infarction, including two patients with both types of infarction. The CI group had a significantly higher proportion of males, higher prevalence of blurred vision, and higher Indian Takayasu Clinical Activity Score (ITAS) 2010 than the non-CI group. Binary logistic regression analysis indicated that hyperlipidaemia (OR 5.549, p = 0.021), ITAS 2010 (OR 1.123, p = 0.023), number of involved arteries (OR 1.307, p = 0.018), and middle cerebral artery (MCA) involvement (OR 4.013, p = 0.029) were significantly associated with CI in patients with TA. Receiver operating characteristic curves indicated fair performance of the ITAS 2010 (> 6) and number of involved arteries (> 7) for distinguishing TA patients at risk of CI from those without such risk. Hyperlipidaemia, higher ITAS 2010, larger number of involved arteries, and MCA involvement are independent risk factors for CI in TA patients. © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.