Blunt carotid and vertebral arterial injuries are uncommon but have the potential for devastating consequences. The classic presentation is a neurologic deficit unexplained by computed tomographic scan findings. Screening patients based on injury mechanisms and patterns allows the diagnosis and treatment of injuries while they are still asymptomatic, potentially improving neurologic outcomes. The development of a grading scale may help refine treatment guidelines. Accessible grade II, III, and V carotid injuries should be repaired surgically. Anticoagulation should be considered first-line therapy for grade I and IV, and inaccessible grade II and III carotid lesions, and grade I-IV vertebral injuries. Grade V and persistent grade III lesions may be best treated employing endovascular techniques.