Cervical artery dissections (CAD) account for up to 25% of strokes in patients younger than 45 years of age and may also occur in older patients. Local symptoms such as headache, neck pain, or Horner's syndrome often precede ischemic symptoms. Three main pathophysiological events are responsible for the clinical symptoms of CAD: brain or retinal ischemia caused by distal embolization or hemodynamic compromise; stretching, compression, or ischemia of adjacent structures by outward expansion of the vessel; and subarachnoid hemorrhage (SAH) in the case of rupture of the arterial wall. The diagnosis of CAD has to be established rapidly to allow immediate treatment and prevent ischemic events. During the last few years, combined MRI/MR angiography (MRA) with fat-suppression techniques has replaced conventional angiography as the diagnostic gold standard. Thrombolysis is a therapeutic option in CAD with severe acute ischemic stroke.