Primary subarachnoid hemorrhage is a rare event in the preterm infant and is most often diagnosed at the postmortem examination. An extremely preterm infant who developed septicemia from Staphylococcus aureus infection in the second postnatal week and presented with hypotension, metabolic acidosis, anemia, thrombocytopenia, and seizures is reported. Cranial ultrasound revealed a large extra-axial fluid collection involving the left parietal cortex that at postmortem examination was observed to be a large left-sided primary subarachnoid hemorrhage. The subarachnoid hemorrhage is most likely secondary to events associated with septic shock and probable disseminated vascular coagulopathy.