Between April 1976 and April 1986, cervicocephalic arterial dissections were diagnosed in 19 of 4531 patients undergoing cerebral arteriography for acute cerebrovascular symptoms. Most dissections were extracranial. Spontaneous cases were as frequent as those following known trauma. Cerebral infarction was the most common presentation. Thirteen patients received only medical therapy, and six had surgery. Most patients survived the initial insult. Many questions remain to be answered regarding the optimal management of this condition, but treatment should be individualized based on clinical status, computed tomography, and angiographic findings.