Performance <p>Spontaneous dissections of the cerebral arteries are among the leading causes of stroke in young adults. They result from hemorrhage into the outer layers of the arterial wall, which can lead to stenosis or even complete vessel occlusion. Clinical presentations vary, ranging from localized pain to cerebral ischemic complications. Early recognition of dissection warning signs and diagnosis through imaging is crucial due to the high risk of recurrent transient ischemic attack (TIA) or stroke within the first two weeks following a dissection, necessitating immediate therapeutic or prophylactic intervention.</p> Achievements <p>Magnetic resonance imaging (MRI) is the imaging modality of choice, as it can reliably visualize all characteristic features of dissection. Typically, thin-slice, fat-saturated 3D black-blood sequences are sufficient to detect the pathognomonic intramural hematoma.</p> Practical recommendations <p>Acute treatment and secondary prevention depend on the extent of neurological deficits, the location and size of the dissection, any sequelae, concomitant pathologies, and risk factors. In most cases, spontaneous vascular recanalization or regression of vessel stenosis occurs within several months due to resorption of the mural hematoma.</p>