Background: Children presenting with acute hemiplegia/ hemiparesis can be diagnostically challenging. Causes of acute cerebrovascular stroke in children are diverse and more complex than those in adults. Stroke is more common than brain tumors in children. Objectives: To identify clinical presentation and role of diagnostic radiology in early detection of cases with ischemic stroke. Patients and Method: Forty patients were enrolled in this descriptive study(1months to 12 years of age) who presented with acute onset of sudden neurological deficit. All patients were admitted in Al-Hussein and Sayed-Galal University Hospitals over aperiod of 8 months from February 2016 to September 2016.All patients were submitted for full history taking and complete neurological examination. Also, patients were investigated by C.T. scan and MRI. Results: We studied 40 cases, 28 males and 12 females. Their ages at presentation ranged from 1 month to 12 years. Hemiplegia/paresis was the most common clinical picture present in all patients; right sided were 25 cases (62.5%) and left sided were 15 cases (37.5%). Upper motor neuron facial palsy, seizures and disturbed level of consciousness all were observed in 13cases (32.5%).  Aphasia was founded in 10 cases (25%), and headache was observed in 6 cases (15%).The present study revealed that cardiac diseases congenital  acquired were the most frequent risk factors identified in this study (17/40- 42.5%) followed by hematological ones (13/40- 32.5%). Conclusion: Hemiplegia was the most presenting symptom. Cardiac disorders were the most prevalent risk factor. Magnetic resonance imaging with diffusion weighted is the best imaging modality for early diagnosis of ischemic cerebrovascular accident.