Atypical presentation of subarachnoid hemorrhage: case report and review of the literature.

Subarachnoid hemorrhage is a threatening condition often associated with significant morbidity and mortality. The risk of rebleeding and ischemic complications can be markedly reduced when the prompt diagnosis of cerebral aneurysmal rupture is made. The sudden onset of severe headache with or without neurologic deficit raises the clinical suspicion, however atypical symptoms exist making the diagnosis difficult. A 49-year-old male with a 3-day history of neck discomfort, without headache, was admitted following a generalized seizure. A serum sodium of 115 mEq/L was noted. A computed tomographic scan of the brain revealed a subarachnoid hemorrhage. Two intracranial cerebral aneurysms were identified by cerebral angiography and subsequently treated. The diagnosis and treatment of subarachnoid hemorrhage is reviewed.