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A retrospective study by Gaul et al. of 102 patients with aortic dissection showed that 29% of patients presented with neurologic symptoms. Interestingly, almost 1/3 of these patients reported NO chest or back pain...i.e. painless aortic dissection with neurologic manifestations. Neurologic presentations discussed in the study include: stroke-like symptoms, syncope, ischemic neuropathy, somnolence, seizures, coma, and spinal ischemia. Pearl: Consider the possibility of aortic dissection in patients with neurologic symptoms especially if symptoms are unusual or combined with other findings. Gaul C, et al. Stroke 2007 From Emergency Medical Abstracts (July 2007)