An 88-year-old female with a history of anemia and hypertension presented to the emergency room with the acute onset of the worst headache of her life after walking into a supermarket. On neurological examination, she had no focal deficits; her only complaint was a severe global headache and neck pain. A computed tomography (CT) scan of the head and cervical spine revealed diffuse acute SAH within the basal cisterns that extended inferiorly down to through the cervical-medullary junction, attended by mild acute hydrocephalus [Figures 1 and 2]. Preliminary imaging with a CT angiogram of the head and neck were unremarkable for vascular pathology. She subsequently underwent formal angiography, which revealed an incidental bilobed, left cavernous carotid aneurysm measuring 3 by 5 mm. As the authors could not attribute the diffuse SAH to this cerebral aneurysm, they ordered a magnetic resonance (MR) imaging scan of the brain and cervical spine [Figures 3 and 4]. The cranial MR showed no other abnormalities, but the cervical MR revealed degenerative cervical disease at the C5-C6 level including a large disc osteophyte complex contributing to flattening of the ventral cord. At the C5-C6 level of maximal cord compression, there was a small pseudoaneurysm arising from the anterior spinal artery [Figures 5 and 6]. The patient remained in the neurosurgery Intensive Care Unit until postbleed day 9. She was then transferred to the floor and subsequently discharged to a subacute rehabilitation facility. She was seen in clinic 3 months later, remaining neurologically intact. After completing a course of rehabilitation, she is now living at home 4 months later with assistance.