Stroke after oral trauma in children is a rare but catastrophic event. We describe two cases of stroke in children after each child fell with a writing instrument in the mouth. Both children had a latent period prior to the onset of neurologic symptoms. Ischemic infarction in the distribution of the middle cerebral artery was present in both cases. Both children were left with permanent hemiparesis. The case reports are reviewed and diagnosis and therapy are discussed. Emergency physicians should be aware of the risk of neurologic complications following apparently asymptomatic oral trauma.