Stroke is rare in children, with an incidence of 2.6 to 3.1/1 000 000. Cerebral infarction occurs among children of all ages. The causes of stroke may be thrombotic, embolic, or hemorrhagic. Most commonly, pediatric stroke is caused by structural abnormalities of cerebral vasculature, inflammatory conditions that involve cerebral vessels, or congenital heart disease. Diagnosis still relies heavily on clinical recognition of the cardinal signs of focal cerebral injury. Topographic determination of the injured cerebral area has been enhanced by the advent of neuroradiologic methods such as MRI. Nonetheless, several disorders may mimic presentation of focal cerebral infarction; differentiating them from stroke depends heavily on an accurate history and physical examination.