To analyze the clinical manifestations and imaging features of ischemic stroke caused by vertebral artery dissection (VAD), and discuss its treatment and outcome. Methods: Five cases of ischemic stroke caused by VAD were reported and the relevant literature were reviewed. Results: Dizziness/vertigo were the main onset symptoms for all the subjects. Two cases had inducement of violent neck movement and had pain in the back neck and occiput at the onset. Head MRI showed lesions in occipital cortex, basal ganglia, thalamus, cerebellum and dorsolateral medulla oblongata. Head MRA/CTA demonstrated dilation, stenosis and occlusion of the vertebral artery. All patients had VAD in DSA with occlusion or stenosis, and 2 cases combined with basilar artery stenosis. HR MRI showed intermural hematoma, dissection valve, and vessel wall enhancement and thickening. Five cases were treated with antithrombotic therapy. After follow-up 3 to 6 months, two patients had recanalization and no one had stroke recurrence. We collected data of 1972 cases of VAD from the MEDLINE. The most common symptoms were dizziness/vertigo, headache, and neck pain in order. Stroke was common, especially with extracranial dissections, whereas transient ischemic attack and subarachnoid hemorrhage (SAH) were uncommon. SAH were only with intracranial dissections. Most patients have a good outcome. Conclu? sion: The possibility of VDA should be considered in the cases of young and middle-aged patients with sudden dizziness, occipital or posterior cervical pain and without obvious risk factors for atherosclerosis. Careful medical history enquiry and further HR-MRI examinations are effective means to discover VAD. Patients diagnosed and treated early have good prognosis.