Type A dissection complicated by cerebral malperfusion and coma may pose decision-making challenges. We describe the case of a patient who presented coma in the context of acute type A aortic dissection, without cardiac tamponade. Brain MRI was performed 4 hours after the onset of symptoms to evaluate the brain perfusion and viability. We discuss the potential role of the currently available emergency brain MRI as an additional tool in the workup of aortic dissection, and its potential to discriminate between irreversible brain injury and brain viability.