## 4 Discussion  
The results highlighted very strong correlations of the serum IL-6 and VEGF levels with the disease severity and strong correlations with the infarct size and functional outcomes six months post-stroke. For markers such as CNTF, APAs, endoglin, and the S100B protein, the correlations ranged from moderate to weak. Nonetheless, a statistically significant but non-linear relationship was identified between the S100B protein levels and disease severity (\(p<0.023\)), ischemic focus size (\(p<0.017\)), and six-month functional outcomes (\(p<0.052\)). Additionally, significant correlations were observed between the ENG levels and variables such as the disease severity, infarct size, functional outcomes, APAs, IL-6, VEGF, and CNTF (\(p<0.0001\) to \(p<0.001\)). These findings support VEGF being a strong peripheral marker for acute pediatric IS and IL-6 being a strong marker of inflammation in this context. CNTF, APAs, endoglin (CD105), and S100B were identified as supplementary markers, ranked in descending order of relevance. However, the role of ENG/CD105 in recovery after stroke and brain injury remains unclear. Our findings revealed that lower serum CD105 concentrations in children with acute stroke impaired recovery processes. A deficiency of ENG/CD105 may hinder recovery from ischemic brain injuries. Although the literature on the role of ENG is inconclusive, evidence suggests its involvement in stroke recovery processes. Endoglin (ENG) is recognized as a receptor associated with transforming growth factor \(\beta\) (TGF\(\beta\)) and plays a critical role in vasculogenesis and angiogenesis. Angiogenesis is vital for the development of cerebral vasculature and the pathogenesis of cerebrovascular diseases, including pediatric ischemic stroke. Ischemia triggers a significant increase in the microvascular density, indicative of angiogenesis, within the penumbra of cerebral infarctions. Enhanced angiogenesis has been linked to improved functional outcomes in both animal models and human stroke patients. Research by [PERSON], [PERSON], and others has shown a high expression of ENG in the penumbra of human stroke lesions, correlating with increased angiogenesis [11,18]. These findings are consistent with the present study, which identified that ENG deficiency impairs recovery in cerebral ischemic lesions by reducing angiogenesis, delaying inflammation resolution, and exacerbating ischemic damage. These impairments contribute to hypoxia and delayed neurobehavioral recovery. The researchers [PERSON] and [PERSON] et al. demonstrated that cytokine levels increase following a stroke due to the heightened production of inflammatory cells, glial cells, and neurons [6]. Key cytokines involved include IL-1, IL-6, IL-10, tumor necrosis factor alpha, and TGF\(\beta\). This aligns with the current findings, which underscore the role of VEGF as a strong prognostic marker in pediatric IS. The detection of elevated serum VEGF levels at disease onset and their dynamic presence over six months showed a significant correlation with patients' functional status at six months post-stroke. These observations establish VEGF as a reliable predictor of the prognosis in children with IS. Another significant finding was that comorbidities in children with acute IS did not influence the levels of the investigated biomarkers in peripheral circulation. This suggests that some biomarkers are specifically indicative of brain lesions in children with IS. Elevated VEGF levels in peripheral circulation were strongly associated with childhood disabilities, such as paresis, paralysis, communication disorders, and epilepsy. Consequently, VEGF can be considered a sufficient marker for predicting the IS prognosis in children and for reflecting the presence of brain injury detectable in peripheral blood during IS events. Understanding the involvement of immunoenzymatic factors in ischemic brain injury may offer new therapeutic opportunities to improve outcomes in children.