Post stroke cognitive impairment (PSCI) is one of the common complications after stroke, mainly manifested as damage to multiple cognitive domains such as attention, memory, and executive function, which seriously affects the quality of life of patients. At present, the pathogenesis of PSCI has not been fully elucidated, and there is a lack of effective treatment strategies in clinical practice. In recent years, studies have shown that the Sonic Hedgehog (Shh) signaling pathway can play an important regulatory role in the pathological evolution and functional recovery of PSCI by regulating pathological processes such as neuroinflammation and cell apoptosis, as well as participating in repair mechanisms such as blood-brain barrier repair, angiogenesis, and neuroplasticity. This article systematically summarizes the mechanism of the Shh signaling pathway in PSCI, with a focus on its regulatory role in nerve injury and repair, in order to provide theoretical reference for the basic research and clinical intervention of PSCI.