BACKGROUND: Acute hemiplegia in childhood may be the presenting sign of stroke, intracranial haemorrhages, tumors, infection and migraine, or may occur after a seizure (Todd’s paralysis). The pediatric causes of stroke are very different from adult causes and include: cerebral vascular malformations, intracranial infections , coagulopathies, vasculitides, congenital and acquired heart disease as well as immunological and metabolic disorders. OBJECTIVES: This study was conducted to determine and evaluate the etiology and outcome of acute hemiplegia in a cohort of Egyptian children .METHODS: This prospective study was carried out in Children’s University Hospital, Cairo University over a 1-year period from June 2008 to July 2009. Admitted children with acute onset of aquired hemiplegia attributable to vascular and non-vascular causes were included in the study. The diagnosis was made based on the clinical presentation , laboratory investigations and brain imaging including CT and MRI scans as well as magnetic resonance venography / arteriography and CT venography.RESULTS: Thirty-five cases were included in the study; Their ages ranged from 2 months to 12 years where 71.4 % of them were male (25 cases). Other presenting features included seizures (57.1%), disturbed conscious level (51.4%) , fever (48.6 %) , upper motor neuron facial paresis (31 .4 %) and aphasia (28 . 6 %). Cerebrovascular disorders were the underlying etiology for acute hemiplegia in 24 / 35 cases (68.6%). Among these cases arterial ischemic stroke was the most frequent diagnosis in 16 cases (66.7%) followed by hemorrhagic stroke in 5 cases (20.8%) , cerebral venous sinus thrombosis in 2 cases (8.3%) and Sturge weber syndrome in 1case only (4.2%).Intracranial infections were encountered in 11 / 35 cases representing 31.4%. Non-specified viral encephalitis in 5 cases (45.5%) , herpes simplex viral encephalitis in 3 cases (27.3%) , brain abscess in 2 cases (18.2%) and acute demyelinating encephalomyelitis in 1 case (9.1%) .Risk factors were identified in 21/23(91.3%) of the stroke patients , hematological disorders were the most prevelant aetiology in 7 cases out of 23(30.4%) followed by cardiac diseases in 6 cases(26.1%), vasculopathy in 4 cases ( 17.4%) , dehydration in 3 cases (13%), and suspected metabolic disorder in 2 cases(8.7%). The inhospital mortality of pediatric stroke patients was 7 /23cases (29.2 %), full recovery was encountered in 4 (16.7 %) and partial recovery with residual paresis was noted in 13 cases (54.2%) . No fatalities were detected in cases due to intracranial infections, full recovery was attainable in 6 /11cases (54.5%) while 5 cases (45.5%) were discharged with residual paresis.CONCLUSIONS: Cerebrovascular disorders and intracranial infections constitute the most significant causes for acute hemiplegia in Egyptian children. Hematological disorders being the most common risk factor for stroke followed by cardiac disorders .