## 1 Introduction  
Stroke is a rare condition in children and adolescents, often underestimated, but it has a significant impact on morbidity and mortality. The incidence of pediatric stroke is 2-13/100,000 for ischemic stroke (IS), 1-5/100,000 for hemorrhagic stroke, and 0.67/100,000 for cerebral venous thrombosis (CVT) [1]. IS most commonly occurs in the prenatal period and within the first 28 days after birth, with a frequency of 1 in 4000 live births [1]. Fetal IS occurs between the 14 th week of gestation and birth. This condition is caused by an ischemic lesion that can occur from 20 weeks of gestation to 28 days postnatal, with an occurrence rate of 1 in 2300-5000 live births and an estimated annual mortality rate of 3.49/100,000 [1]. Neonatal IS, a subcategory of pediatric IS, leads to significant morbidity and long-term neurological and cognitive deficits, including cerebral palsy, epilepsy, neurodevelopmental disabilities, behavioral disorders, and vision and language impairment. In some children, neonatal IS is recognized retrospectively when hemiparesis or seizures occur [2]. The study of the epidemiology, determinants, and predictive aspects of pediatric Disability-Adjusted Life Years (DALYs) is a current issue in contemporary neurology, both locally and globally. The incidence of neonatal IS is increasing in the Republic of Moldova, highlighting the need for research on the predictive and therapeutic aspects of IS in children during early developmental stages to optimize the medical, psychological, and educational resources. As defined by the World Health Organization (WHO), stroke is a vascular disease characterized by the rapid-onset focal or global impairment of brain activity, which can lead to death, with symptoms lasting at least 24 h. This definition also includes arterial occlusion or venous thrombosis leading to IS [3]. According to the WHO classification, stroke can be categorized into several types. Transient ischemic stroke (TIS): Ischemia in a localized area of the brain with a motor deficit lasting up to 24 h (minutes to hours), without neurological sequelae [4]. Involutional stroke: Acute cerebral ischemia with a motor deficit lasting more than 24 h, with complete resolution within 21 days [4]. Lacunar IS: A type of stroke in which the blood flow is blocked in a group of very small arteries within the brain, primarily those supplying deep brain areas. Ischemic brain lesions in these cases range in diameter from 2 to 20 mm [4]. Evolving ischemic stroke: A stroke with a slow, progressive course, lasting from a few hours to several days. Clinical symptoms persist for more than three weeks, with motor deficits evolving or resolving in about 30 days. If it progresses, it may lead to constitutive IS, resulting from neuronal destruction in the affected vascular territory and causing the clinical presentation of a definite motor deficit [4]. According to several investigators, stroke is defined as a focal neurologic deficit lasting more than 24 h, with neuroimaging evidence of cerebral infarction [4]. In cases where the neurologic deficit resolves within 24 h and there are no neuroradiiologic changes, the event is classified as a transient ischemic attack. However, if clinical manifestations last less than 24 h but neuroimaging reveals signs of infarction, the event is considered an ischemic stroke. [PERSON] et al. define pediatric stroke as a sudden focal infarction of brain tissue, diagnosed either through neuroimaging or post mortem examination, which may result in arterial stroke or venous infarction. A stroke occurs when there is an abrupt occlusion of one or more cerebral arteries. In children, arterial stroke is the most common subtype, accounting for just over half of all strokes [4]. [PERSON] et al. describe pediatric stroke as a cerebrovascular event occurring during fetal or neonatal life, up to 28 days after birth, with radiologic evidence of a focal arterial infarction of the brain. This type of stroke is 17 times more frequent in the perinatal period than later in infancy [5].