Objective To study the relationship between levels of homocysteine (HCY) and adiponectin (ADP) and carotid artery intima-media thickness (IMT) in patients with atherosclerotic cerebral infarction (ACI). Methods A total of 300 patients with ACI treated in the Department of Neurology, Dafeng Hospital of Chaoyang District, Shantou were enrolled in the study. After ultrasonic detection of carotid artery outer segment, the patients were divided into the normal endometrium group (85 cases), the mild stenosis group (140 cases) and the moderate to severe stenosis group (75 cases) according to different IMT. The HCY, ADP and IMT were compared among the three groups. Results The IMT of normal endometrium group was thinner than 0.9mm, and AS plaque score was 0. The proportion of carotid atherosclerosis, number of atherosclerotic plaques and plaque scores were significantly higher in the mild stenosis group and the moderate to severe stenosis group than the normal endometrium group. There were significant differences in HCY, ADP and IMT in the mild stenosis group and the moderate to severe stenosis group, compared with those in the normal endometrium group. With the increase of IMT, HCY increased while ADP decreased, and changes of above indexes in the moderate to severe stenosis group were greater than those in the mild stenosis group. With the increase of HCY and the decrease of ADP, IMT increased. Serum HCY was positively correlated with IMT while serum ADP was negatively correlated IMT. Serum HCY and ADP were independent risk factors of IMT thickening. Conclusion The increase of serum HCY and the decrease of ADP are the risk factors of IMT thickening. Serum HCY is positively correlated with IMT while serum ADP is negatively correlated with IMT.