Multiple aneurysms of the PICA communicating artery: a case report

A case with unusual type of aneurysms in the distal posterior inferior cerebellar artery (PICA) is reported here. Though only two cases with a single aneurysm of the PICA communicating artery have been reported previously, the present case is the first one with multiple aneurysms in the PICA communicating artery. A 61-year-old woman with a sudden onset of severe headache, vomiting and unconsciousness was transferred to our hospital. CT scan revealed a hematoma in the fourth, third, and lateral ventricles, and a mild subarachnoid hemorrhage at the posterior fossa. Cerebral angiogram showed the right PICA supplying the hypoplastic left PICA territory through an anastomotic vessel. Two small aneurysms were seen at the tips of hairpin curves of an anastomotic vessel, "the PICA communicating artery". Suboccipital craniotomy was performed, and the ruptured aneurysm was clipped and the unruptured one was wrapped with cotton-sheet After the operation, her clinical recovery went well and she was discharged on foot.