From Benign Symptoms to Subarachnoid Hemorrhage: A Pediatric Case

Pediatric intracranial aneurysms are rare and represent an uncommon but life-threatening cause of subarachnoid hemorrhage in children. Their diagnosis is usually delayed because early symptoms are nonspecific and often mimic benign pediatric conditions. We report the case of a 13-year-old boy who presented with a one-week history of progressive headache and vomiting and was repeatedly evaluated at multiple healthcare facilities, where he was treated for suspected gastroenteritis and sinusitis. He clinically declined on the day of presentation with sudden worsening of headache, photophobia, and an episode of generalized tonic-clonic seizure, prompting emergency transfer to our institution. He was fully oriented on examination with no focal neurological deficits, but was drowsy, with neck stiffness. Non-contrast computed tomography of the brain demonstrated diffuse subarachnoid hemorrhage with intraventricular extension and mild hydrocephalus. Computed tomography angiography subsequently identified a ruptured aneurysm arising from the right posterior communicating artery as the source of the bleed. The patient was managed with close neurological monitoring, seizure prophylaxis, and measures aimed at controlling intracranial pressure. As neurointerventional services were not available locally, arrangements were made for urgent transfer to a tertiary neurovascular center. At the tertiary center, an external ventricular drain was placed for intracranial pressure control. The patient subsequently made a good neurological recovery and was discharged without residual deficits. This case highlights the diagnostic challenges of aneurysmal subarachnoid hemorrhage in children and emphasizes the importance of early neuroimaging in patients with persistent or progressive neurological symptoms.