title: Clinical problem-solving: aneurysm or spinal arteriovenous fistula-bait and switch.
abstract: OBJECTIVE
  The authors use an instructive case to review the challenges of diagnosis in subarachnoid hemorrhage (SAH) and to reinforce the nuances of clinical management.
  
  
  OBJECTIVE
  The presented case highlights critical issues in patient selection and challenges in the diagnosis of SAH and the management of both aneurysmal and arteriovenous fistula-related SAH. The critical points in decision making and diagnosis are discussed, and the case is accompanied by a brief review of the literature on the issues being faced.
  
  
  METHODS
  The present case is a patient presenting with SAH who was found to have an anterior communicating artery aneurysm. However, clues in the presentation and workup point to another etiology.
  
  
  CONCLUSIONS
  A strong history of sudden neck pain before headache and abundance of SAH along the brainstem mandates a need to thoroughly evaluate the source of hemorrhage from cervical vessels through an angiogram.
authors.affiliation: Goodman Campbell Brain and Spine, and Indiana University Department of Neurological Surgery, Indianapolis, Indiana 46202, USA.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Lastfogel
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Boulis
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
mesh_terms: D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis* / Q000601:surgery*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000002:abnormalities* / Q000098:blood supply / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome