Extrapyramidal symptom masquerading as subarachnoid hemorrhage

A subarachnoid hemorrhage without typical presentation often poses a great challenge to an emergency physician. A 36-year-old man presented to our emergency department with symptoms mimicking extrapyramidal symptoms but was ultimately found to have a ruptured intracranial aneurysm. Emergency craniotomy and aneurysm clipping were performed. Interestingly, involuntary movements of his face, mouth, and limbs diminished soon after the operation. The patient fully regained his verbal function and completely restored his muscle power. A full neurologic examination is emphasized for timely diagnosis to prevent catastrophic deterioration, especially in patients with verbal dysfunction or with a psychiatric disorder.