Rare Presentation of Rabies as Subarachnoid Hemorrhage

Background: Rabies is transmitted to humans through the saliva of an infected animal. Case: We report a rare case of rabies encephalitis presenting with subarachnoid hemorrhage. An elderly gentleman presented with behavioral disturbances and rapid worsening in sensorium. Neuroimaging showed diffuse subarachnoid hemorrhage, hydrocephalus, and right vertebral dissecting aneurysm requiring extraventricular drainage. He had history of dog bite 4 months prior with incomplete immunization. Despite adequate management, his condition deteriorated further and succumbed to death. Autopsy confirmed the diagnosis of rabies. Conclusions: Rabies encephalitis can pose a diagnostic challenge requiring an extensive diagnostic evaluation because of its variable and uncommon clinical and radiological presentations.