Diagnosis of subarachnoid hemorrhage indicated by transthoracic echocardiography

We report the case of a 63-year-old woman who presented to her local emergency department unresponsive and in a state of cardiogenic shock 4 hours after the sudden onset of a severe headache. Her electrocardiogram revealed nonprogressive 1-mm S-T elevation in leads V(5) to V(6) and a prolonged QTc. A transthoracic echocardiogram performed at the time of her resuscitation revealed regional wall-motion abnormalities not consistent with any known coronary artery territory but consistent with a diagnosis of acute subarachnoid hemorrhage. This diagnosis was subsequently confirmed on computed tomography brain imaging. Although subarachnoid hemorrhage is known to be associated with cardiopulmonary dysfunction, and electrocardiogram and echocardiogram abnormalities, the diagnosis of subarachnoid hemorrhage suspected by echocardiography before brain imaging has not previously been described.