Aneurysmal subarachnoid hemorrhage associated with weight training: three case reports.

Weight training is a popular component of physical fitness in North America. This form of training remains relatively safe with few cases of life-threatening injuries. However, a series of studies have demonstrated that repetitive upper- and lower extremity weight training incorporating a Valsalva maneuver can increase arterial pressure to values as high as 480/350 mm Hg. This marked increase in arterial pressure is transmitted to the cerebral vasculature and increases cerebral arterial transmural pressure and may have the potential to initiate the rupture of a previously innocuous intracranial aneurysm. We report three cases of subarachnoid hemorrhage (SAH) associated with arm (bicep) curls and leg press weight training and discuss the possible link between this form of exercise and aneurysmal SAH.