Aortic dissection presenting as acute ischemic stroke

Aortic dissection is an uncommon, life-threatening, and treatable emergency that typically presents with tearing chest and back pain.1 With use of the Stanford classification, aortic dissections can be divided into type A (involving the ascending aorta) and type B (involving the aorta distal to the origin of the left subclavian artery).2 Type A dissections may cause ischemic stroke in up to 5 to 10% of patients3 through extension of the dissection into the common carotid arteries or through thromboembolism or cerebral hypoperfusion. A 64-year-old man was referred to the neurologist for evaluation of acute stroke. He had a history of hypertension. He was reversing his car when he suddenly grasped his hands to his chest and “blacked out.” He was briefly unresponsive but began to speak with garbled speech and had a Wernicke aphasia. He arrived at the hospital within 30 minutes of onset. His blood pressure was 180/120 mm Hg …