Subarachnoid hemorrhage (SAH) is a life-threatening cause of headache. The diagnostic approach to this entity continues to evolve with a recent questioning of the classic workup of computed tomography and lumbar puncture. We report a risk management case of a patient with a missed SAH resulting in a fatal outcome. When there are multiple diagnostic strategies, the patient may be involved with shared decision-making. Some of the medical and legal implications of the diagnosis of SAH will be discussed.