UNEXPLAINED NEUROLOGICAL DEFICIT WITH IMPAIRED VASCULAR PERFUSION: A MISSED TELL-TALE SIGN OF AORTIC DISSECTION PRESENTING IN A DISTRICT HOSPITAL Acute aortic dissection can present with a diverse range of clinical signs and symptoms. It is a condition with high morbidity and mortality that could be missed without a high index of suspicion. This case examines a 45-year-old gentleman who presented to a district hospital with hemodynamically unstable, acute right-sided body weakness associated with a fall the day prior. He also reported frank haematuria, with suprapubic, pelvic, and right thigh pain for the past three days. A preliminary diagnosis of cerebral vascular accident with a need to rule out intracranial bleeding was made, and he was arranged for an urgent computed tomography brain scan at a secondary hospital. Unfortunately, he eventually succumbed to cardiac tamponade secondary to aortic dissection. This case highlights the challenge clinicians face in identifying a vascular emergency that disguises with a history of trauma. This challenge is further amplified in hospital settings with scarce resources and expertise. Therefore, a thorough history taking, a focused physical examination, and a high index of suspicion are crucial for making an accurate diagnosis.