Acute convexity subarachnoid haemorrhage : a cause of aura-like symptoms in the elderly

Late-life onset aura-like symptoms are not rare and can be potentially misdiagnosed as transient ischaemic attacks. The cause is often obscure. Four cases of recurrent aura-like symptoms are presented in whom acute convexity subarachnoid haemorrhage (SAH) contralateral to symptoms was demonstrated. Three experienced subsequent events or groups of events triggered by recurrent SAH. Negative diffusion-weighted imaging, normal electroencephalography and slow symptom march with complete resolution argued against ischaemic and epileptic causes. Aura-like symptoms in the elderly should be investigated with imaging modalities most sensitive for detecting subarachnoid blood, in particular gradient echo magnetic resonance imaging.