Subarachnoid hemorrhage: atypical features of a rare disease

Abstract

Introduction: Subarachnoid hemorrhage is a rare cause of headache with a high mortality rate and serious long-term neurological sequelae. This case has an atypical presentation, which should raise suspicion for the diagnosis. Case report: We present the case of a 50 year-old man from Angola, with a history of allergic rhinitis and chronic sinusitis. He is a member of a nuclear family in phase V of the Duvall family life cycle, in Graffar social class IV. His father died at age 54 from an intracranial hemorrhage. The patient presented with fever, coryza, and headache of 12 hours’ duration, accompanied by vomiting. The patient had elevated blood pressure on physical examination, without neurological deficits, with pain on cervical flexion, without neck stiffness. Given the possibility of acute meningitis and, less likely, subarachnoid hemorrhage, he was sent to the emergency room of the local hospital, where the diagnosis of aneurysmal subarachnoid hemorrhage was confirmed. He was admitted for surgical treatment for the aneurysm. He survived the surgery without neurological deficits. Comment: The differential diagnosis of headache ranges from benign and prevalent causes, to life-threatening, rare diseases. This case report, in addition to addressing a rare disease in primary health care, shows an unusual presentation, which highlights the core competencies of the General Practitioner.