Non-aneurysmal subarachnoid hemorrhage (NASAH) is defined as bleeding into the subarachnoid space without an identifiable aneurysm. In patients with long-standing diabetes mellitus (DM), chronic microvascular damage may contribute to vascular fragility and hemorrhage. Emerging evidence suggests a possible association between NASAH and diabetes, particularly through microangiopathic mechanisms. We report the case of a 40-year-old female patient with a 14-year history of poorly controlled Type 1 DM (T1DM) who presented with sudden-onset severe occipital headache, neck stiffness, and vomiting. On examination, she was neurologically intact with a Glasgow Coma Scale score of 15/15, with mild nuchal rigidity. Non-contrast head CT revealed diffuse subarachnoid hemorrhage. CT angiography showed no aneurysm or vascular malformation, confirming NASAH. She was managed conservatively with nimodipine, analgesics, and supportive care, with good clinical recovery and no residual deficits. This case highlights NASAH as a potential microvascular complication of long-standing T1DM. Early recognition and appropriate imaging are essential for diagnosis, particularly in resource-limited settings, and can lead to favourable outcomes.

Dawit Yosef Barkesa, MD, is a medical professional and researcher from Ethiopia, affiliated with Negelle Arsi General Hospital and Medical College. He serves as a General Practitioner and has contributed to clinical and medical research, with interests spanning clinical medicine, case-based research, internal medicine, orthopedic care, and healthcare improvement. He has been involved in research addressing important clinical and healthcare challenges, including a case report on cerebral venous sinus thrombosis during the postpartum period and research related to the development and outcomes of a hip arthroplasty program in rural Ethiopia. His academic work reflects a strong interest in improving patient care, advancing medical knowledge, and supporting evidence-based healthcare practices, particularly in resource-limited settings. Through his clinical and research activities, he continues to contribute to the understanding of diverse medical conditions and the development of healthcare services in Ethiopia.