Pitfall of Diagnoses in Young Patients with Subarachnoid Hemorrhage

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The case of a 20-year-old male who suffered severe headache, vomiting and epilepsy is presented. On admission he was found to be drowsy and had left side abducens palsy. A computed tomogram (CT) showed subarachnoid blood in the basal cistern, a caudate head hematoma, and intraventricular hemorrhage extending from the anterior horn of the lateral ventricle to the 4th ventricle. Four-vessel angiography did not reveal an aneurysm or an arteriovenous malformation. An angiogram repeated 18 days after admission revealed a saccular aneurysm arising from the bifurcation of the internal carotid artery. This was successfully clipped and the patient was there discharged. We report here a rare case of adolescent subarachnoid hemorrhage stressing the importance of repeat angiography.