Spinal subarachnoid hemorrhage mimicking an acute abdomen

A 39-year-old woman with a history of systemic lupus erythematosum developed an acute abdomen. An intestinal ischemia was suspected and an exploratory laparotomy was performed. No abnormalities were found during surgery and five days later the patient was transferred to our institution. On admission, the patient presented a distended abdomen and paraparesis. The spinal tap showed hemorrhagic CSF and the MRI a subacute subarachnoid hemorrhage (SAH) of the dorsal-lumbar spine. Two days later, the patient suffered an episode of sudden headache. The CT scan revealed an acute SAH at the posterior fossa and digital subtraction angiography a dissection of the right V4 segment. Spinal subarachnoid hemorrhage is a rare syndrome particularly when associated with dissecting aneurysms of the intracranial segment of the vertebral artery. SSAH should be considered early in the differential diagnosis of any case with sudden back or abdominal pain of unknown etiology, even in the absence of neurological deficits.