Aortic dissection (AD) is a life-threatening condition that presents with diverse and atypical symptoms, making it challenging to diagnose. This case study focuses on a woman in her 40s who presented to the emergency department with collapse, right-sided weakness, agitation, and confusion. Despite efforts, she died before a definitive diagnosis was made. The post-mortem examination revealed hemopericardium due to dissection of the ascending thoracic aorta as the cause of death. AD is a rare occurrence with varied clinical presentations, often leading to missed or misdiagnosed cases. Timely diagnosis and intervention are crucial for patient survival. Neurological symptoms can also manifest if the carotid, vertebral, spinal arteries, or vasa nervorum are affected. Ischemic stroke is the most common neurological presentation. This case highlights the importance of a high index of suspicion in patients presenting with neurological symptoms and risk factors for AD. It serves as a reminder of the challenges in diagnosing AD and the need for increased awareness among healthcare professionals to prevent missed diagnoses and adverse outcomes.