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Despite recent advances in our understanding of pediatric arterial ischemic stroke, the etiology of many cases remains elusive: in up to 22% of cases in hospital series no cause is found1 (table). While congenital heart disease and sickle cell disease account for a large proportion of childhood strokes, stroke is rarely the first presenting feature of these diseases, and thus they seldom explain a stroke in an otherwise healthy child. Prothrombotic risk factors such as protein C deficiency and the Factor V Leiden mutation have been associated with childhood stroke, but are only modest risk factors that alone provide an incomplete explanation. Vascular pathology, however, has been increasingly implicated …
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