Background Paediatric stroke is a neurological injury that can lead to significant morbidity and mortality. Stroke remains among the top 10 causes of death in children and its morecommon causes are cardiac disorders, blood disorders, vasculopathiesand metabolic disorders.

Aim We aim to describe two clinical cases of different diseases, wherestroke was the first manifestation.

Material and methods wepresenttwo clinical cases: (1) a2-year-old girl diagnosed with MELAS syndrome and (2) a 14-year-old girl of with systemic lupus erythematosus (SLE), both patients with clinical signs of stroke.

Results The 2-year-old patientwas admitted in our clinic with status epilepticus, motor deficit, shortage of speech and language, cognitive disorders. The MRI showed multiple areas of cerebral ischemia located in the left hemisphere. The laboratory tests highlightedlactic acidosis, coagulation abnormalities and central nervous system and cardiovascular system damage. The echocardiographic examination revealed cardiomyopathy. Thus the diagnosis of MELAS syndrome was made.The second patient presented the following clinical manifestations: headache, cognitive dysfunction, hemiplegia. The brain MRI showed multiple areas of ischemia.The laboratory analysis revealed anaemia, increased ofacute phase reactants, increased titers of antinuclear antibodies, increased titers of anticardiolipin IgM and IgG antibodies and elevated titer of IgM and IgG antiphospholipid antibodies. The clinical diagnosis of systemic lupus erythematosus (SLE) was established.

Conclusions These results suggest that stroke may be the initial manifestation of other severe disease (in our case – mitochondrial disorder, MELAS syndrome and autoimmune disease, SLE). In children, multiple brain structures are involved,at the very onset the clinical symptoms are generalised, nonspecific and polymorphous. Nevertheless, in teenagers, brain nonatheroscleroticvasculopathies are more likely to be responsible for developing of stroke and the clinical syndrome correlates with focal neurological deficits.