Stroke is a leading cause of mortality and permanent disability worldwide, with ischemic and hemorrhagic strokes being the two primary categories. Ischemic stroke, caused by insufficient blood flow to the brain, accounts for nearly nine out of ten cases. The TOAST classification identifies five subtypes: large artery atherosclerosis, cardioembolic infarction, lacunar infarction, other determined etiology, and undetermined etiology. Hemorrhagic stroke involves bleeding into the cerebral parenchyma. Understanding the molecular mechanisms underlying these conditions is crucial for developing effective treatments. Key molecular mechanisms in ischemic stroke include excitotoxicity, calcium overload, oxidative stress, and neuroinflammation. Non-coding RNAs (ncRNAs), particularly microRNAs (miRNAs) and long non-coding RNAs (lncRNAs), play critical roles in angiogenesis and neuroprotection, making them potential therapeutic, diagnostic, and prognostic tools. The review highlights the intricate molecular mechanisms of ischemic and hemorrhagic strokes, focusing on the role of miRNAs in brain damage. It also explores new therapeutic approaches based on molecular mechanisms, in addition to traditional stroke therapies. The introduction provides an overview of stroke epidemiology, risk factors, and the pathophysiology of ischemic and hemorrhagic strokes. The molecular mechanisms section delves into the roles of excitotoxicity, calcium overload, oxidative stress, and neuroinflammation, with a detailed analysis of cytokines and immune cell recruitment in ischemic brain injury. The discussion on neuroimmune crosstalk emphasizes the complex interactions between the central nervous system and the immune system, highlighting the balance between damaging and neuroprotective immune responses.Stroke is a leading cause of mortality and permanent disability worldwide, with ischemic and hemorrhagic strokes being the two primary categories. Ischemic stroke, caused by insufficient blood flow to the brain, accounts for nearly nine out of ten cases. The TOAST classification identifies five subtypes: large artery atherosclerosis, cardioembolic infarction, lacunar infarction, other determined etiology, and undetermined etiology. Hemorrhagic stroke involves bleeding into the cerebral parenchyma. Understanding the molecular mechanisms underlying these conditions is crucial for developing effective treatments. Key molecular mechanisms in ischemic stroke include excitotoxicity, calcium overload, oxidative stress, and neuroinflammation. Non-coding RNAs (ncRNAs), particularly microRNAs (miRNAs) and long non-coding RNAs (lncRNAs), play critical roles in angiogenesis and neuroprotection, making them potential therapeutic, diagnostic, and prognostic tools. The review highlights the intricate molecular mechanisms of ischemic and hemorrhagic strokes, focusing on the role of miRNAs in brain damage. It also explores new therapeutic approaches based on molecular mechanisms, in addition to traditional stroke therapies. The introduction provides an overview of stroke epidemiology, risk factors, and the pathophysiology of ischemic and hemorrhagic strokes. The molecular mechanisms section delves into the roles of excitotoxicity, calcium overload, oxidative stress, and neuroinflammation, with a detailed analysis of cytokines and immune cell recruitment in ischemic brain injury. The discussion on neuroimmune crosstalk emphasizes the complex interactions between the central nervous system and the immune system, highlighting the balance between damaging and neuroprotective immune responses.