## 5 Discussion
According to several researchers [11] ischemic stroke is defined when a focal neurological deficit occurs that lasts more than 24 h, with neuroimaging evidence of cerebral infarction. In the case of a neurological deficit that recovers before 24 h and there are no neuroradiiological changes, the event is called a transient ischemic attack. If the clinical manifestations last less than 24 h, but there are neuroradiiological signs of infarction, it is considered an IS [11]. According to the authors [PERSON] et al., stroke in children is defined as a sudden focal infarction of brain tissue, diagnosed by neuroimaging or at autopsy, which may lead to arterial stroke or venous infarction. An IS occurs when there is a sudden occlusion of one or more cerebral arteries. In children, arterial ischemic stroke is the most common subtype, accounting for just over half of all cerebrovascular accidents [12]. Some authors mention in their papers [13] that IS in children can present with subtle symptoms, especially among newborns and small children. According to researchers, the clinical manifestations and risk factors of IS in children are different from those of adults; therefore, the disease can be considered an independent nosological entity [13; 14]. To address the issue of uncertain clinical symptoms of IS in children and newborns, a significant aspect of the study involved evaluating the clinical signs of IS in that population. Consequently, all signs exhibited by patients were considered potential diagnostic and prognostic features and were statistically analyzed. The most relevant signs, which demonstrated a significant association with IS, were then incorporated into the algorithms. The following standardized measures served as the basis for characterizing all clinical signs assessed in the study. Stroke symptoms in early childhood are usually nonspecific, and in older children, they often manifest as focal neurological deficits, such as acute hemiplegia. The neurological examination should highlight the most subtle symptoms suggestive of a stroke, including monitoring of vital parameters, identifying neurological damage and suggesting the presumptive diagnosis and brain topography involved. As a rule, some systemic diseases that increase the risk of stroke must be excluded. The suggestive symptoms for damage to a cerebral vascular territory are the following: (1) internal carotid artery--hemiparesis, aphasia, and hemianopsia; (2) anterior cerebral artery--hemiparesis, especially in the lower limbs; (3) middle cerebral artery--hemiparesis of the upper limbs, hemianopsia, and aphasia; (4) posterior cerebral artery--hemiparesis, hemianopsia, ataxia, and dizziness; (5) basilar artery--difficulty breathing, sensory or balance disturbances, ataxia, nystagmus, opisthotonus, tremors, and vomiting; (6) cerebellar artery--sensory deficit, headache, fever, vomiting, and cerebellar signs [6]. The clinical manifestation of IS in children varies depending on the age, the involved artery and the cause [3]. Focal symptoms, especially hemiplegia, are most frequently present in hemorrhagic stroke and vary according to different authors. The clinical presentation of IS is diverse, and common IS symptoms such as altered consciousness, convulsions, etc., may be encountered. The diagnosis of pediatric ischemic stroke is based on the recognition of clinical manifestations depending on the age and the cerebral vascular system involved. The statistical analysis in this study revealed distinct clinical symptom patterns as the most relevant for IS in children of different age groups:  
1. Children aged between 28 days and 1 year old presented one-sided body weakness, one-hand preferential use, focal epileptic seizures, and impaired consciousness. These symptoms were significant indicators of ischemic stroke in that age group. Children aged between 1 and 3 years old exhibited one-sided body weakness, focal movement disorder, focal epileptic seizures, speech disorders, psychomotor agitation, and impaired consciousness.