The predictive value of presenting symptoms, MRI and CT findings, and etiology in the outcome of ischemic arterial childhood stroke was determined in a consecutive series of 31 patients followed at the University Hospital, Rotterdam, The Netherlands. Hemiparesis was the most common presenting symptom (74%), seizures occurred in 19%, altered level of consciousness in 16%, and ataxia in 7%. Location of infarction on neuroimaging was in the territory of the middle cerebral artery (MCA) in 27 cases, basilar artery (BA) in 4, and in the cerebellum involving the posterior inferior cerebellar artery (PICA) in 2. Three MCA and 2 MCA and ACA strokes (19%) were complete. Etiology was identified in 24 (77%), including cardiac surgery complications in 6, varicella zoster-related in 5, mitochondrial disease in 2, migraine-related in 2, and Moya-Moya, Kawasaki disease, factor V Leiden, sickle-cell disease, and hyperthyroid crisis in 1 each. Risk factors at presentation that correlated with a poor prognosis were an altered level of consciousness, seizures, and a completed stroke of the MCA. Etiology, age at presentation, or gender showed no significant correlation with outcome. 
COMMENT. Almost one-half the patients in this study died or had severe residual morbidity. The early risk factors for this poor outcome were an altered level of consciousness at presentation, seizures, and MRI evidence of complete or end-zone MCA infarction.