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. 2023 Aug;7(3):175-177.
doi: 10.5811/cpcem.1586.

The Diagnostic Dilemma in Delayed Subarachnoid Hemorrhage: A Case Report

Danielle A Bazer  1   2 , Nicholas Koroneos  1 , Matthew Orwitz  1 , Jordan Amar  3 , Ryan Corn  1 , Elizabeth Wirkowski  1
Affiliations

The Diagnostic Dilemma in Delayed Subarachnoid Hemorrhage: A Case Report

Danielle A Bazer et al. Clin Pract Cases Emerg Med. 2023 Aug.

Abstract

Introduction: Radiologically negative subarachnoid hemorrhage (SAH) has a low incidence and is associated with good clinical outcomes.

Case report: We present the case of a 44-year-old male with new-onset headaches, which began one week prior while bike riding. At an outside hospital, he had normal computed tomography head and angiogram. He declined a lumbar puncture. Over the following week, the headache was persistent. He lacked meningeal signs. Repeat studies were normal. Lumbar puncture was positive for xanthochromia.

Conclusion: Radiologically negative SAH should be included in the differential diagnosis of patients presenting with unremitting headache in the setting of recent exercise, despite negative imaging, and meningeal signs.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image
Image
This is a normal magnetic resonance image of the brain. There is no blood in the perimesencephalic area.
See this image and copyright information in PMC

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