Aortic dissections (AD) are a frequent cause of sudden death and are typically associated with chest, back, and/or abdominal pain. Several cases of AD with neurologic presenting symptoms, such as paresthesia, headache, and seizures were noted at the Pima County Office of the Medical Examiner (PCOME) in Tucson, Arizona. Our aim was to compare the location of AD with central nervous system (CNS) versus classic symptoms. Retrospective data were collected from the archives at the PCOME from 2001-2014. There were 61 natural death cases involving the aorta with known antemortem symptoms; 43 cases of AD with classic (non-CNS) symptoms and 18 cases with CNS symptoms. The cases were classified based on Debakey and Stanford classification systems. Patients with CNS symptoms had a greater proportion of Debakey type II dissections (44%) than without CNS symptoms (16%). This association was statistically significant ( = 0.0337, chi-square test). Seventeen percent of cases with CNS symptoms had AD involving the carotid arteries, and involvement of the carotid arteries was significantly associated with CNS symptoms ( = 0.0227, Fisher's exact test). There were a higher percentage of females with CNS symptoms (44%), than without CNS symptoms (23%). Our findings suggest a need for a higher index of suspicion and further investigation of cases with neurologic symptoms, focusing particularly on the aortic arch and its branches.