Subarachnoid hemorrhage with negative cranial CT and psychiatric symptoms as the first manifestation:a case report and literature review
Chen Zeming
Fang Xiang
Ruan Bingkun
Wang Yulan
Han Xinli
Tang Yujie
Zhu Luyao
Abstract：Subarachnoid hemorrhage (SAH) is a life-threatening cerebrovascular disease, usually caused by rupture of blood vessels at the base or surface of the brain, leading to bleeding into the subarachnoid space. The main clinical symptoms are sudden severe headache, nausea, vomiting, with or without focal signs. Physical examination may show positive meningeal irritation signs, and cranial CT may reveal high-density shadows in the cerebral sulci, cisterns, and fissures. With typical clinical manifestations, the diagnosis is not difficult [1]. However, due to differences in the amount, extent, speed, time, and distribution of SAH bleeding, the clinical presentation can be complex and diverse [1]. Some patients with SAH may not present with headache as the initial symptom. If the cranial CT does not show abnormalities, it is often misdiagnosed as various types of headaches, epilepsy, cervical spondylosis, meningitis, or mental disorders [2]. In October 2023, the First Affiliated Hospital of Anhui University of Chinese Medicine admitted a case of SAH presenting initially with psychiatric symptoms and negative cranial CT, initially diagnosed as viral encephalitis. By reviewing and analyzing the clinical data of this case and combining relevant literature, we aim to improve the diagnostic and therapeutic level of this disease among clinical physicians.
Keywords：Subarachnoid hemorrhagePsychiatric symptomsCranial CTLumbar puncture
Publication Date：2025-10-20
Online Publishing Date：2025-10-29(First online date of this platform, not the publication date of the document)
Pages：4( 757-760 )