Stroke in young people is an unexpected event, whose causes are more heterogeneous than in the older population. Moreover, its diagnosis must exclude a large number of other diseases. Thereby, imaging plays an important role in the diagnostic approach of these patients. The aims of the neuroradiological work-up are to confirm that an acute ischemic lesion has occurred, to determine the location and the extent of the lesion, to verify the patency of major neck and intracranial arteries and to exclude eventual underling pathologies. In this sense, MRI offers the best sensitivity and spatial resolution. The more frequent causes of ischemic stroke in young people are considered and the correspondent characteristic imaging aspects are described.