Although pediatric stroke is rare, it is a leading cause of morbidity and mortality in children. The diagnosis of stroke is often delayed in children, which can contribute to death and disability. Management of pediatric stroke is challenging because there are few data to support the efficacy of interventions, and management is based on society guidelines and expert opinion, as well as extrapolation from adult stroke management. This issue reviews the most common causes of pediatric stroke, provides guidance for distinguishing stroke from stroke mimics, discusses the indications for laboratory studies and imaging modalities, and offers evidence-based recommendations for treatment.