Cerebral venous thrombosis (CVT) may rarely manifest itself with pure subarachnoid hemorrhage (SAH). For a neurosurgeon, spontaneous SAH always suggests vascular pathologies as aneurysms or malformations. However, though rarely encountered, a spontaneous SAH may be an initial finding of CVT that requires prompt diagnosis with venous angiography to initiate treatment with anticoagulants. Obviously those are contraindicated in aneurysmal subarachnoid hemorrhage. Literature review discovered additional cases presented in this article. CVT may manifest itself with subarachnoidal hemorrhage atypically with a localized pattern rather than diffuse blood. A spontaneous subarachnoidal hemorrhage in atypical localization may be related to venous thrombosis and radiologic evaluation of cerebral venous system should be one of the initial diagnostic efforts in neurosurgical practice of such cases for early initiation of treatment with anticoagulants.