Introduction: Stroke and cerebrovascular disorders are already amongst the top 10 causes of childhood death. Patients with homocysteinemia may present with vascular thrombotic events, with or without the traditional risk factors for a stroke. Objectives: The aim of this study was to measure plasma homocysteine levels and lipid profile (serum cholesterol, triglycerides, HDL and calculation of LDL) in pediatric patients with ischemic or hemorrhagic stroke. Assess the role of homocysteinemia as an associated risk factor in pediatric ischemic stroke. Correlate the results with the clinical data of the patients. Materials and Methods: Across-sectional case control study was carried out on 60 pediatric patients, divided into two groups: group A contained 30 pediatric patients with ischemic stroke and group B contained 30 pediatric patients with hemorrhagic stroke, they were recruited from outpatient clinics or admitted to PICU (pediatric intensive care unit) in Assiut university children hospital and Qena university hospital, Upper Egypt, after approval of the university hospital ethical committee. The control group __ampersandsignldquo;group C__ampersandsignrdquo; contained 30 healthy age and sex matched subjects. Biochemical assay of plasma homocysteine and lipid profile among the previously mentioned groups were done. Results: The plasma homocysteine level showed statistically significantly higher levels among group A when compared with group B and group C (P-Value 0.0001). There was no significant difference in plasma homocysteine among group B when compared with group C (P-Value 0.9). Regarding the lipid profile assay in the studied groups, serum triglyceride level, cholesterol and low density lipoprotein (LDL) were significantly high among group A in comparison with group B and group C (P-Value__ampersandsignlt;0.0001), while high density lipoprotein (HDL) level was significantly low among group A in comparison with group B and group C( PValue__ampersandsignlt;0.0001). There was a positive correlation between plasma homocysteine level and both LDL and triglyceride levels while a negative correlation between plasma homocysteine level and HDL level. Conclusion: Elevated plasma homocysteine can be considered as an associated risk factor among pediatric patients with ischemic stroke that could be explained by its atherogenic and thrombotic effects. This was associated with hyperlipidemia.