文章报道1例老年男性患者，因“突发意识障碍20 h”入院，无胸闷、胸痛和腹痛症状。急诊头颅磁共振成像（MRI）检查提示左侧颞顶叶皮质局灶性亚急性小梗死灶；查体发现左、右上肢血压不对称；胸部增强CT提示为主动脉夹层动脉瘤破裂入心包。因此，对于以脑梗死为主要临床表现的患者一定要重视神经系统以外的体征，以免漏诊，应尽早明确诊断，及时正确治疗。

One old male patient was admitted to the hospital due to “consciousness disorders for 20 h”, with no presentation of chest distress, chest pain and abdominal pain. Emergency MRI demonstrated subacute focal infarction of left temporal-parietal gyri, physical examinations revealed the asymmetric blood pressure of  bilateral upper extremities, and aortic dissection was indicated by chest enhanced CT. Therefore, careful analysis of clinical manifestations and early diagnosis are important for treatment of aortic dissection among those with cerebral infarction as main presentation.