Effective management of patients who have cerebrovascular disease depends on accurate diagnosis. Many conditions cause clinical findings that closely mimic cerebrovascular disorders and are often ruled out through brain imaging or laboratory findings. Diagnosis of cerebrovascular disorders is based on the presence of risk factors for vascular disease, the tempo of onset, the presence of concurrent conditions, and the clinical course of development of neurologic symptoms and signs. This article shares a process by which clinicians can combine a patient’s history, neurologic examination, and brain and vascular imaging to localize a lesion and diagnose cerebrovascular disease.