Neurological symptoms, such as unconsciousness, aphasia and limbs weakness, are common clinical manifestations of stroke. But atypical presentations due to rare etiology may delay correct diagnosis. We present a 54-year-old female stroke patient with transient consciousness disturbance, hypotension and profound cold sweating. The initial diagnosis was acute infarction stroke. Carotid duplex ultrasound showed bilateral common carotid artery, carotid bifurcation, internal carotid artery and external carotid artery dissections. Stanford type A aortic dissection was diagnosed after CT angiography and thoracic computed tomography. Unfortunately, she passed away soon after emergent aortic vascular surgery. Typical symptoms of aortic dissection are characterized by severe tearing chest and back pain and high blood pressure. When patients present with atypical symptoms, non-invasive tests such as bilateral limb pulse, blood pressure measurements, carotid duplex ultrasound and echocardiography could provide important clinical clues. Additionally, blood tests, such as D-Dimer, may also help initial differential diagnosis. Computerized tomography should be performed immediately when aortic dissection is suspected clinically to reduce the probability of delayed diagnosis or misdiagnosis and irreversible morbidity or death.