Nonaneurysmal Subarachnoid Hemorrhage Following Corticosteroid Therapy in a Child with Sickle Cell Disease

Subarachnoid hemorrhage (SAH) is a rare but potentially life-threatening complication in children with sickle cell disease (SCD). While ischemic strokes are well-documented in this population, spontaneous nonaneurysmal SAH remains uncommon, particularly following corticosteroid therapy. We report the case of a school-aged female with homozygous SCD who developed an acute bifrontal headache 5 days after completing a course of corticosteroids for incomplete Kawasaki disease. Initial evaluation revealed elevated blood pressure, and a noncontrast computed tomography scan demonstrated moderate right frontal sulcal SAH without evidence of vascular anomalies on angiography. Management was conservative, consisting of antihypertensive therapy and discontinuation of corticosteroids and aspirin. The patient remained neurologically intact and demonstrated complete clinical and radiological recovery on follow-up. This case suggests a potential association between corticosteroid-induced hypertension and SAH in children with SCD, potentially related to the underlying cerebral vasculopathy and vascular fragility inherent to the disease. Although causality cannot be definitively established, the temporal relationship and clinical features are consistent with prior case reports. Being a single case, causal inference is inherently weak, and the proposed association remains speculative; moreover, the lack of similar local or regional cases limits contextual generalizability. Corticosteroids, while often necessary, should therefore be used with caution in pediatric SCD patients, with close monitoring of blood pressure to mitigate the risk of hemorrhagic complications. Take-Home Message: Careful blood pressure monitoring is advised when corticosteroids are used in children with SCD, given the potential for hypertensive or hemorrhagic complications.