Dissection of the epiaortic vessels is an emerging cause of focal cerebral ischemia, especially in young patients. Non-invasive diagnostic devices (ultrasound, nuclear magnetic resonance) have greatly improved the ability to suspect and identify it. We report our clinical experience with 5 patients affected by carotid artery dissection and 2 patients affected by vertebral artery dissection. Vessel dissection generally occurred spontaneously; it was preceded by head or cervical trauma in 2 cases. Arterial hypertension was commonly associated, and headache was always present together with other focal neurological signs. Clinical suspicion was confirmed by ultrasound duplex scanning: although never conclusive, it always showed typical Doppler patterns. Nuclear magnetic resonance has become an acknowledged means of definitive diagnosis although angiography remains the gold standard. In any case, diagnosis requires clinical suspicion and the accurate correlation of clinical data and instrumental results. Therapy consisted in anticoagulant and antiplatelet drugs. The clinical course of our patients was favorable in all cases, and no recurrences were recorded.