Aortic dissection (AD) is a rare cardiovascular emergency with a high rate of mortality. Most patients present with typical signs and symptoms of AD. However, atypical presentation increases risk of delay in diagnosis and treatment. Patients may present with syncope, seizures or other neurological symptoms which may deceive the diagnosis of AD. Dissection can be in the acute or chronic phase, but there has been no documentation of an acute dissection which occurs in a chronic dissection. We hereby to report a case of an acute on chronic thoraco-abdominal dissection.