Type A dissection complicated by cerebral malperfusion and coma may pose
decision-making challenges. We describe the case of a patient who
presented coma in the context of acute type A aortic dissection, without
cardiac tamponade. Brain MRI was performed 4 hours after the onset of
symptoms to evaluate the brain perfusion and viability. We discuss the
potential role of the currently available emergency brain MRI as an
additional tool in the workup of aortic dissection, and its potential to
discriminate between irreversible brain injury and brain viability.