Chapter 20: Subarachnoid Hemorrhage

Excluding head trauma, the most common cause of subarachnoid hemorrhage (SAH) is rupture of an intracranial saccular aneurysm; other etiologies include bleeding from a vascular malformation (arteriovenous malformation or dural arteriovenous fistula) and extension into the subarachnoid space from a primary intracerebral hemorrhage. Approximately 2% of the population harbor aneurysms, and 25,000–30,000 cases of aneurysmal rupture producing SAH occur each year in the United States; rupture risk for aneurysms <10 mm in size is ∼0.1% per year; for unruptured aneurysms, the surgical morbidity rate far exceeds the percentage.