The term cervico-cephalic arterial dissection (CAD) encompasses a group of arteriopathies not necessarily with an identical pathogenesis but that have in common an intramural hemorrhage. This most frequently affects the extracranial arterial segments, predominantly the internal carotid artery (ICA), the vertebral artery (VA), or multiple arteries in typical locations. Spontaneous cervico-cephalic arterial dissections (sCAD) have typical predilection sites in the different arteries affected, which in part may be explained by mechanical influences: high cervical segment of extracranial ICA or V2 and V3 segments of VA. In the case of a severe head and/or neck trauma, the pathogenesis is straightforward. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) have replaced angiography as the gold standard, at least in the extracranial segments of ICA and VA. The risk of having a stroke or transient ischemic attack (TIA) after having suffered a CAD in general is very low.