Introduction
Patients with acute aortic dissection (AD) and intramural hematoma (IMH) can present with a variety of symptoms including cerebral ischemic in addition to classical chest pain. Catastrophic outcomes in AD cases mistakenly treated with tissue plasminogen activator (tPA) have been reported [1-2]. It is crucial to rule out AD/IMH in stroke patients. Moreover, treatment of type A IMH with stroke is controversial and our case illustrates success with a delayed surgical repair.