[72-year-old man with syncope and left hemiparesis]

A 72-year-old man was admitted with left hemiparesis after a painless syncope with suspected ischemic stroke. So far he was a healthy man without any cardiovascular risk factors. A computed tomography scan of the head did not show any abnormal findings. In the clinical evaluation we revealed pulse deficits in the left-sided extremities and the blood pressure of the left arm was not measurable. The final diagnosis was an acute aortic dissection, beginning in the proximal portion of the ascending aorta, leading to the iliacal arteries. The patient was transferred and surgery was performed immediately with success. Painless acute aortic dissection presenting only with neurologic symptoms made the correct diagnosis extremely difficult. Correct diagnosis, however, is essential, otherwise thrombolytic therapy - indicated for acute-stage cerebral infarction - would have been performed, probably with a fatal outcome.