Stroke is the sudden occlusion or rupture of cerebral blood vessels resulting in focal cerebral damage causing clinical neurologic deficits. Strokes in children are relatively rare and diagnosis is frequently delayed. Stroke is either ischemic (either arterial embolic or thrombotic or venous sinus thrombosis) or hemorrhagic. Risk factors for stroke in children include cardiac abnormalities (eg, atrial septal defect, ventricular septal defect, cyanotic heart disease, myocarditis, endocarditis, arrhythmias), vascular abnormalities (eg, vasculitis, lupus, moyamoya, Ehler-Danlos syndrome, fibromuscular dysplasia, AV malformation, Sturge-Weber syndrome), hematologic disorders (eg, sickle cell disease, protein C or S deficiency, antithrombin III deficiency, thrombocytopenia), metabolic disorders (eg, homocystinuria, organic acidurias, mitochondrial disorders), trauma (eg, child abuse, arterial dissection, blunt cervical arterial trauma, intraoral trauma), or systemic disorders (eg, diabetes mellitus, hypertension). Typically, stroke is an acute neurologic event manifesting as hemiparesis with or without seizures, which are relatively frequent at stroke onset in children compared to adults. Seizures, fever, headache, lethargy occur more commonly in younger children. Dystonia is more common in children with basal ganglia infarction. Neonatal strokes manifest with persistent acute focal seizures.