 Good morning everyone. Myself Dr. Dukawari Kavatkimat and my co-authors for this paper are Dr. Vipakshi Hattioli and Dr. Mahesh Kamte. I am from Jain Medical College, Kahar, Belgam, Karnataka. Today I will be presenting a paper on pictorial review of CT and MRI features of unusual causes of ischemic stroke in young children. Ischemic stroke in young children is now emerging as a public health issue, one in which radiologists can play an important role. About half of the surviving patients develop some neurologic or cognitive impairment and just more than a quarter epilepsy. Thus, radiologists must expand their differential diagnosis to appropriately diagnose ischemic strokes and identify their causes in the pediatric population. This paper focuses on the unusual causes of radiologic imaging features of pediatric ischemic stroke, which includes Moyamoya disease, mineralizing angiopathy and Bohunter syndrome in less than 15 years of age. Learning objectives are that the pictorial review of CT and MRI features of unusual causes of ischemic stroke in young children. Discussion. So first coming to the Moyamoya disease. So Moyamoya disease is an arterial disorder causing ischemic stroke in young patient. This occurs primarily in the female sex in two age groups, the first decade of life and the fourth to fifth decades. Characteristic angiographic features of the disease include stenosis of or occlusion of the arteries of the circular phyllis as well as the development of collateral vasculature. This occlusion is located at the branching of the anterior cerebral artery and or middle cerebral artery when they come off the little carotid artery. When it is only one sided or associated with other medical conditions, it is termed as Moyamoya syndrome. These medical conditions include diseases such as Down syndrome and Sickle cell disease. So here in the first set of image, there was a girl, a three years old female child who presented with a history of left sided weakness. These figures depict left MCA territory, non-hemorrhagic subacute in fact with occlusion of left cavernous and supra-clinoid ICA and M1 segment of left MCA. Here, a eight year old male child who presented with a history of right sided weakness, the figures depict right MCA territory and ACA-MCA watershed territory, non-hemorrhagic subacute in fact with occlusion of M1 segment of right MCA and other cause being mineralizing angiopathy. Mineralizing angiopathy is one of the rare cause of acute ischemic stroke involving the basal ganglia after minor head trauma which constitute less than 2% of all child's ischemic stroke. The mechanical forces during head trauma causes rapid brain displacement resulting in excessive stretching of artery at the point of arterial thethering. The acute angle between MCA and lenticular strat arteries and relatively unminerated brain increases the risk of mechanical injury. So here is a case of five year old female child who presented with a history of fall from bed following which she had a loss of consciousness followed by right hemiparosis. The first set of figures depict linear punctate calcifications in bilateral lentiform nucleus with chronic lacuna infarcts in bilateral lentiform nucleus. Another case of a three years old child who had a history of fall after one week the child had a history of left hemiparosis. These figures depict punctate calcification in the head of cordate nucleus and lentiform nucleus on right side with subacute lacuna infarcts in bilateral lentiform nucleus and right head of cordate nucleus. Another cause of ischemic stroke being Bohunters syndrome. Bohunters syndrome also known as occlusion of the vertebral artery with head rotation leading to ischemia and sometimes stroke is rarely described in children. It is often unilateral and in children has primarily been described in voice. Various ethylogical factors include formation of the cervical vertebral canal or soft tissue anomalies such as ligamentous laxity and anomalous muscular and fibrous bands. This includes rotatory atlanto-axial subluxation, atlanto-oxipotin ligament calcification, venginital aquaid foramen, oscius anomalies caused by Cripple-Fill syndrome and odontoid aplacia. So here is a 2 years old female child who presented with history of imbalance since 3 days. These figures depict subacute infarct in left cerebellar, lobe and pons. The flesh-tidal image shows obliteration of pre-medullary space which is depicted in the LO arrow. The 3D top image shows occluded left vertebral artery in its entire length which is depicted as a asterisk. Another case of a 14 year old female child who presented with history of imbalance while walking. These figures depict subacute infarct in bilateral cerebellar lobes with obliteration of pre-medullary space and a narrow right vertebral artery in its entire length which is depicted in the 3D top image. Conclusion, ischemic stroke in young children is an emerging public health issue given the rise in incidence and prolonged period of disability that requires urgent multidisciplinary competence and approach. In both the cases of ischemic and hemorrhagic origin, the logical approach to be obtained in the emergency leads to the first screening and first therapeutic possibility. These are the references which are referred for this paper. Thank you.