Background: Children have a more diverse and larger number of risk factors for arterial ischemic stroke (AIS) that differ significantly from adults which are predominated by hypertension, diabetes, and atherosclerosis. The aim of the present study was to inspect and conclude the most common risk factors and causes of AIS in children. Patients and methods: A prospective cohort study included 24 patients admitted to Pediatric Department, Faculty of Medicine, Zagazig University Hospitals. Full history taking, clinical and neurological examination and routine laboratory examination were performed. Neurological outcomes were graded by the site neurologists as no deficit, mild, moderate, or severe deficits and patients were followed up. Results: More than one half 58.3% of arterial ischemic stroke patients had single infraction, mainly at left side 45.8%, affected mainly Anterior circulation (58.3%). The vascular imaging artropathy subtype of Arterial Ischemic Stroke patients nearly two fifths was arteropathy type (12.5%) , Moyamoya, the same percent was arterial dissection. The outcome of treatment arterial ischemic stroke patients 37.5% of them became normal early. After follow up period one half of them became normal. Unfortunately 16.7% had severe deficit at early follow up and still at late follow up period. About1 patient(4.2%) died pre discharge, 2 patients (8.3%) died post discharge, 2 patients (8.3%) related to ischemia, other patient (4.2%) unrelated ischemia. Conclusion: Cardiac lesion is the most risk factors associated with arterial ischemic stroke, followed by arterioropathy, prothrombin disorder and diabetes.