Children presenting with acute hemiplegia/ paresis 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. It is one of the top ten causes of childhood death in high-income countries; it is increasingly recognized as an important cause of morbidity and mortality. The aim of the present study was to evaluate and describe the clinical pattern and aetiology of cerebrovascular accident and to assess the role of neuroimaging in detection cases with early stroke in Egyptian children presenting with acute hemiplegia that were recruited from causality department or from inpatient departments of Abou El-Rish Children's University Hospital tertiary center, in Cairo, Egypt over the period from January 2012 to April 2013. We studied 40 cases, 28 males and 12 females. Their ages at presentation ranged from 2 months to 12 years, mean age ± SD was 3.53 ± 3.16 years and median was 3.1 years.