Although an MRI of an acute middle cerebral artery stroke in a two-year-old child may appear quite similar to that in a 60-year-old adult, the similarity is deceptive. Stroke etiologies vary dramatically by age; developmental differences in the BBB, neurotransmitter receptors, and antioxidant enzymes, and inflammatory and cell-death pathways modify the response to ischemia occurring on a cellular level; and differences in brain maturation modify the clinical manifestations of a stroke. These age-related differences must be considered in the acute management of a childhood stroke. A thrombolytic or neuroprotective agent that improves outcome in an adult may not be efficacious in a child. Therefore, in both clinical practice and research, neonatal and childhood stroke must be considered discrete entities.

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