Atypical Presentation of Non-Aneurysmal Subarachnoid Hemorrhage

When most clinicians think of subarachnoid hemorrhages (SAH), they think of “most severe headache of my life” as the most common chief complaint. However, it is only reported in about 70% of patients with SAH. Other symptoms may include nausea and/or vomiting, stiff neck, visual disturbances, loss of consciousness, weakness, and seizures. Patient history may involve previous SAH, hypertension, oral contraceptives in women, recent trauma, family history of intracranial aneurysms, history of smoking, alcohol, and drug use. However, there are atypical causes of SAH that may be missed upon initial evaluation for patients that may not have the above mentioned symptoms or risk factors. When evaluating the patient with a neurological complaint that does not fall in the category of peripheral nervous system distribution, it is worth considering outliers that may be related to the central nervous system, such as a SAH. Working up such differentials leads to proper disposition of the patient population and decreases the possibility of long-term complications or mistreatment