Acute aortic dissection is the most common catastrophic event affecting the aorta. Its early mortality is very high, with a rate of 1-2% per hour, in the early hours, after the dissection takes place. The key symptom is the chest pain presentation, but there are others that may be unnoticed, and they even mask the disease. In this work is described a case with atypical presentation of this disease: a man of 72 years old with a history of hypertension and diabetes mellitus type 2, which went to the emergency service with oppressive chest pain, vomiting and inability to move the lower limbs. When carried out the physical examination, a decrease of peripheral pulses was found in the right lower limb, spastic paraplegia and absent osteotendinous reflexes in both lower limbs. A computed tomographic angio-graphy (CTA) was performed, where an aortic dissection type IIIb was diagnosed. The patient died 24 hours after the diagnosis.
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