Background Ischaemic strokes represent a rare condition in childhood, mostly revealed by a motor deficit. The aim of this study is to present clinical features and aetiology of paediatric arterial ischaemic stroke in childhood and evaluate neuroimaging features and treatment, to establish a reasonable guideline for assessment and management of the disease.

Patients and Methods This study retrospectively reviewed the records of almost all children between the ages of 1 month and 16 years who were admitted to the departments of paediatrics and neurology from 1992 to 2007. The diagnosis of cerebral stroke was confirmed in all patients by cranial imaging. Neonatal stroke and haemorrhagic stroke were excluded from the study, as were patients presenting with transient symptoms.

Results Forty-three children were enrolled. The median age at stroke was 4 years (range 0.2–16). Among patients with determined aetiology, infections (6%), moyamoya disease (20%), trauma (10%) and cardiac disease (27%) were the most common. Fourteen (32%) had no identifiable cause. Hemiplegia was the most common presenting feature (62%). Thirteen children (30%) had seizures. The vascular territories were: middle cerebral artery in 30%, middle and anterior cerebral arteries in 40% and vertebral basilar cerebral arteries in 20%. Adverse outcomes after childhood stroke included death in 5%, recurrence in 7% and neurological deficits in 51%. Eight patients were treated by heparin therapy.

Conclusions Different patterns of risk factors for paediatric ischaemic stroke exist among ethnic groups. A complete investigation, including haematological, neuroimaging and metabolic studies should be considered for every child with stroke.