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Clinical spectrum of Autosomal Dominant Polycystic Kidney Disease (ADPKD) is very wide, ranging from no symptom or mild symptom to renal failure to catastrophic cerebral haemorrhage. Common presentations that can lead to the diagnosis are hypertension, recurrent urinary tract infection, renal failure, abdominal pain or mass, and haematuria. However, cardiovascular complication is the prime cause of morbidity and mortality in ADPKD. Hypertension is the early manifestation which can result in or contribute to other detrimental complications. Here, we report a case of 46-year-old female brought to the emergency department with sudden onset of altered sensorium with no prior history of hypertension, diabetes, heart ailments or any chronic illness. Her Blood Pressure (BP) was 210/100 mmHg with a systolic murmur, palpable kidneys and Glasgow coma scale of 10/15. Funduscopy showed early papilloedema but no retinopathy. Computed Tomography (CT) scan of brain showed Intracerebral Haemorrhage (ICH). Further evaluation led to the diagnosis of ADPKD. Magnetic resonance angiography of brain revealed no aneurysm. She was treated with antihypertensive drugs (telmisartan and nifedepine), prophylactic anticonvulsant (oral levetiracetam) and initially with mannitol as antiedema measure. She was discharged with no residual disability and she is maintaining normal BP on follow-up since 11 months. This case report illustrates that ICH due to undiagnosed or delayed diagnosis of hypertension can still be the leading presentation in ADPKD and more emphasis should be given for screening of masked hypertension which may help in preventing the serious cardiovascular complications.