Acute aortic dissection usually presents with a sudden, painful, tearing sensation in the chest or back. However, acute aortic dissection may also present atypically without pain and with solely neurological symptoms. We describe a case of painless acute aortic dissection which presented as acute left lower extremity weakness and numbness. These neurological symptoms are due to vascular occlusion causing peripheral ischaemic neuropathy. It is imperative to consider acute aortic dissection in the differential diagnosis of acute neurological syndromes.