## 5 Discussion
An international study of clinical and imaging analyses of symptomatic IS summarized various clinical presentations, risk factors, types of investigations, treatments, and early outcomes in IS. The most important clinical symptoms reported were seizures (72%) and nonfocal neurological signs (63%) [19]. However, some studies mention that about 40% of children do not show specific symptoms in the neonatal period; they are recognized later, with the appearance of motor disorders, developmental delays, cognitive impairment, or seizures [20]. Notably, pediatric IS (PIS) leads to significant morbidity and mortality. Of all cases, approximately 10-25% will be fatal, up to 25% of patients will have a recurrence, and up to 66% will have persistent neurological deficits or develop epilepsy, learning problems, or developmental problems. Up to one-third of children who have had a stroke have a history of recent events compatible with transient stroke. Neurological impairment during childhood will have a major impact on the quality of life of the child and the family, but also on the economic and emotional costs of society [21]. Early recognition of PIS requires emergency neurological consultation and hospitalization to provide coherent etiological/pathogenic diagnostic and treatment management and improve outcomes. The diagnosis of PIS is based on the recognition of symptoms according to age and the vessel involved. Signs of stroke in early childhood are usually nonspecific, and in older children, focal neurological deficits are often noted, such as acute hemiplegia. The neurological examination should highlight the most subtle symptoms of a possible stroke, including monitoring of vital parameters, identifying neurological damage, and assuming the presumptive diagnosis and topography of the involved vessel. As a rule, some systemic diseases that increase the risk of IS must be excluded. Neuroimaging is crucial in defining the diagnosis, other tests being necessary depending on the clinical picture. Thus, PIS is better recognized among practitioners as a clinically significant entity [22]. It is known that the diagnosis of stroke in children can often be delayed, and sometimes missed due to mild and nonspecific clinical symptoms and since they are initially related to other causes than stroke. The suggestive stroke symptoms characteristic of a certain age category may improve diagnosis in 66-99.7% of cases [23] if using the mathematical calculations proposed for the prevalence of certain symptoms of the disease. In this context, the results of the study reveal that children with sudden onset of the following clinical symptoms are at high risk of developing IS: focal neurological symptoms, seizures, accompanied by neurological symptoms, visual or speech disorders, mental disorders, impaired coordination or ataxia, headaches, and signs of intracranial tension. For that reason, these clinical signs have to be regarded as predictors of IS, and the patients should undergo an immediate neurological examination for the detection of IS. At the same time, urgent neuroimaging studies are required. Children with suspected ischemic stroke should undergo MRI, as a method of early diagnosis. If an urgent MRI examination is not possible, a brain CT scan should be considered as an alternative, especially in adolescents [24]. Brain MRI or brain CT scanning should be performed in children with suspected hemorrhagic stroke [25]. Based on the symptoms that had a significant relationship with the following stroke event, the data-driven statistical analysis makes it possible for the first time to establish algorithms that enable a clinical plan for fast, time-saving recognition of the stroke diagnosis; thus, it allows the choice of the best, time-dependent treatment options of stroke events in newborns and children of different age groups. Logistic regression was used to derive the algorithms for decision-making regarding stroke diagnosis and its early treatment, to decrease life-long morbidity and mortality of children.