Subarachnoid hemorrhage presenting as acute chest pain: a variant of le coup de poignard

A 39-year-old woman presented to the emergency department with symptoms of acute knifelike chest pain and was discharged with a diagnosis of musculoskeletal pain syndrome. One day later, she returned with a complaint of persistent chest pain. Physical examination disclosed meningismus, this led to a lumbar puncture and the subsequent diagnosis of subarachnoid hemorrhage. Angiography later revealed findings consistent with dissection of the vertebral artery. This case illustrates an unusual presentation and cause of spinal subarachnoid hemorrhage, a potentially treatable emergency condition.