Cerebral ischemic injury is uncommon in children, but the effects are long-lasting with significant implications for the child's development. The precipitating event in ischemic infarct is generally occlusion of the cerebral vessels. This occlusion may the result of direct injury of the cerebral vasculature, thrombus formation, or emboli from more distant sources. A wide variety of conditions are known to predispose to cerebral infarcts in children. However, even in recent studies, the underlying condition is unknown in as many as half the children who suffer an ischemic stroke. To care for these children effectively, it is imperative that extensive evaluations be performed to determine the cause of the cerebral infarct. Furthermore, increasing attention will need to be directed toward the metabolic events of cerebral ischemia. A better understanding of these mechanisms may provide clues to some of the causes of ischemic injury and should lead to more effective treatments.