Fifty-three (5%) of 1064 consecutively imaged children showed an arterial vascular pattern on magnetic resonance images, accounting for 12% of all abnormal studies. Signal abnormalities on T2-weighted scans persisted years after the clinical stroke occurrence. Ipsilateral atrophy of the pons or midbrain was found in 25% of subjects and was strongly associated with congenital lesions. Most infarctions occurred before or during the neonatal period; only 31% were acquired later. We did not find the paucity of posterior circulation lesions or the marked excess of left middle cerebral artery lesions seen in other series. Cardiac disease and venous infarction had an unexpectedly low occurrence. All of the children with arterial border zone infarction had been resuscitated in the neonatal period, while 37% of the children with a single artery infarction had no clinical history of acute illness.