Spinal subarachnoid hematoma (SSH) is a rare entity causing spinal cord or nerve root compression [
1]. In addition to idiopathic spontaneous development, SSH could be caused by trauma, iatrogenic procedures (most frequently due to lumbar puncture), arteriovenous malformations, arteriovenous fistula, spinal artery aneurysms, coarctation of the aorta, coagulopathies (as a result of pharmacotherapy or systemic diseases), neoplastic lesions, systemic lupus erythematosus, necrotizing vasculitis, or Behcet’s disease [
2‐
10]. In most cases, the onset is acutely progressive and requires urgent surgical treatment, although some individuals with chronic SSH have been reported [
11]. The comorbidity of SSH associated with intracranial aneurysmal subarachnoid hemorrhage (SAH) is extremely rare and the exact pathogenesis is unclear [
12]. This paucity of clinical cases poses a challenge for its diagnosis and management in patients with cauda equina syndrome after aneurysmal SAH. This paucity of clinical cases poses a challenge for its diagnosis and management in patients with cauda equina syndrome after aneurysmal SAH. We present a case of acute cauda equina syndrome caused by a SSH after aneurysmal SAH. The clinical aspect, radiological images, pathogenesis, and management are described in this report.