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Psychiatric presentation of aneurysmal subarachnoid haemorrhage

Neurosurgical conditions that present for psychiatric reasons have increasingly been detected as improvements in neuroimaging studies reveal a variety of structural disturbances in major mental illnesses.1 The long-term psychiatric sequelae following treatment of aneurysmal subarachnoid haemorrhage (SAH) is well described in the literature.2,3 There are very few reports, however, of SAH presenting with bizarre behaviour and absence of classic symptoms such as acute onset of headache or signs of meningism. Two recent cases of acute aneurysmal subarachnoid haemorrhage presenting with a florid psychosis are described here.