In the acute phase of a suspected stroke, timely brain imaging with rapid and qualified interpretation is a crucial diagnostic step to inform patient management. While brain computed tomography is usually sufficient to indicate thrombolysis within the approved time window (by rapidly excluding intracranial haemorrhage), it often fails to show the actual site and extent of infarction as well as other pathologies, which may mimic a stroke. Magnetic resonance imaging (MRI) has a much higher sensitivity and specificity for ischaemic vascular brain changes and thus allows direct demonstration of the area(s) of acute ischaemic damage. This helps in the diagnosis of clinically uncertain cases, may give aetiological clues, and can also provide pathophysiologic insights into stroke evolution with respective consequences for patient treatment. The capability to rule out many other disorders that may mimic stroke is also an important asset of MRI. All these advantages make MRI the preferred tool in the workup of young individuals with suspected stroke. However, this needs ready availability and adequately tailored and short imaging protocols in order not to delay treatment.