Rugpijn na een subarachnoïdale bloeding

Subarachnoid haemorrhages (SAH) are acute life-threatening events that are frequently misdiagnosed. 4% of patients with SAH do not have the typical acute intense headaches, but present with other symptoms. Misdiagnosis leads to treatment delays and, consequently, higher morbidity and mortality. We describe two patients with atypical symptoms after SAH and delay in diagnosis. The first patient came to the emergency room with cervical, back and radicular pain that spread to both legs. An acute headache had started 11 days earlier. Physical examination showed signs of meningeal irritation. A cerebral CT scan revealed a subarachnoid haemorrhage. The second patient came to the outpatient clinic with pain in his lower back, apathy, apraxia and unsteady gait after an acute headache had started nine days before. When the patient visited our outpatient clinic, the headache had disappeared. A cerebral CT scan nevertheless revealed a subarachnoid haemorrhage. When diagnosing SAH, it is important not to miss the acute headache in the history, even though this headache may no longer be present at the time of presentation.