Isolated cervical anterior spinal artery (CASA) aneurysms are extremely rare with most of them mostly associated with arteriovenous malformation. The underlying pathology is not known but some factors leading to the aneurysm are inflammatory, infection and connective tissue disorders. Trauma with formation of pseudoaneurysm has also been reported. We report a case which presented with fourth ventricle bleed and was managed successfully with conservative treatment.
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