Cerebral ischaemia might not preclude operation in acute aortic dissection. A 37-year-old male with an acute proximal aortic dissection (type A) and coma and hemiparesis caused by involvement of the arch vessels and secondary brain malperfusion underwent emergency surgical repair with replacement of the ascending aorta in profound circulatory arrest. The patient recovered fully and was asymptomatic and in good health two years after the operation.
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