Arterial ischemic stroke (AIS) in adults is considered a serious health threat and requires urgent medical treatment. Prompt diagnosis allows the therapeutic option of thrombolysis within the time window of 3 to 6 hours after first symptoms. Alternatively, early anti-platelet therapy is effective in improving the outcome after stroke. The incidence of pediatric AIS range from 2 to 5 per 100 000 children/year. Pediatric AIS has severity and long-term outcomes similar to those in young adults. Two-thirds of children sustaining AIS have neurological deficits that may result in life-long disability, thus critically impacting their potential development. On the other hand 10%-30% of the causes of acute strokes are of unknown reasons, therefore careful structural, metabolic and genetic risk factors, requiring more specific treatment, should also be considered in any cases of stroke in children. The diagnosis and treatment should be conducted on the basis of a multidisciplinary approach, including pediatric cardiology, hematology, neurology, neurosurgery and neuroradiology.