Stroke in children is rare. No really good studies of the incidence are available, an estimate, however, is 2-3/100,000 children per year. In this paper we discuss the pathophysiology and the many different causes of stroke in children. In many of the cases more than one prothrombotic condition exists. If the cause is not obvious an extensive programme of examinations is recommended. This is important not only in order to give the best individual treatment, but also necessary in order to decide whether the stroke has a genetic cause. Initially, the treatment is symptomatic, attaching importance to achieving good perfusion of the cerebrum and lowering the energy consumption of the cerebrum. The rational treatment might be prompt reperfusion by thrombolytic medicine: this regime has been tried in adults, but as yet no consensus about this treatment modality exists. In some cases causal treatment is possible. If the stroke has a genetic cause genetic consultation is important and prenatal investigations might be possible. Overall, the mortality in stroke in children is about 25%. About 25% will live without any sequelae and approximately 50% of the children will disabled to a greater or lesser extent.