Abstract INTRODUCTION: Ischemic stroke is rarely seen in childhood. The pediatric causes of stroke are very different from adult causes. methods: This population-based study was conducted to determine the incidence, clinical manifestations and etiology of pediatric ischemic stroke in Southern Khorasan, Iran, during 2002-2007. In this province, every child with possible diagnosis of stroke is referred to a stroke neurologist and routinely admitted to the Pediatric Division of Vali-e-Asr tertiary care hospital. The diagnosis of ischemic stroke was made based on the clinical presentation and brain imagery. All of the patients underwent a standard battery of diagnostic investigations. results: Seventeen children with ischemic stroke (7 girls, 10 boys) were evaluated. The incidence of pediatric ischemic stroke in Khorasan province is 1.8 cases per 100,000 children population per year. Meningoencephalitis-induced vasculopathy constituted 23.5% of the etiology followed by Fallot tetralogy, head trauma, dehydration, migraine, and hypercoagulable state. 23.5% of our patients had uncertain causes of stroke. In-hospital mortality of our pediatric ischemic stroke patients was 11.7%. CONCLUSIONS: The incidence and clinical characteristics of pediatric brain infarction in Iran are the same as in other studies. Meningoencephalitis-induced vasculopathy is the most common determined etiology of pediatric ischemic stroke in Southern Khorasan. Keywords: Child, stroke, incidence, etiology.