South Africa has unique challenges with few radiologists per capita. The development of neuroradiology in South Africa has been driven by relationships and collaborations between South African radiologists and individual, highly regarded Neuroradiologists primarily from North America and Europe who have travelled to South Africa and South African radiologists who have undertaken training abroad, returned, and shared skills. A University of Cape Town graduate founded the discipline of Paediatric Neuroradiology. Paediatric radiologists from the Red Cross War Memorial Hospital have forged significant international careers. There are individuals outside of radiology who have made major contributions: Physicists, including a Nobel Prize winner, Neuropathologists who elevated understanding of radiological pathological correlation and Neurosurgeons who have been leaders in the neurointerventional space which in South Africa is shared by radiologists and neurosurgeons. Despite staffing and financial constraints, there are future opportunities for public-private partnerships, international collaborations, and exchange programs.