A rare case of distal aneurysm of the posterior inferior cerebellar artery (d PICA) found in association with distal anterior cerebral artery (d ACA) and middle cerebral artery (MCA) aneurysms is described. d PICA aneurysm causing subarachnoid hemorrhage was successfully clipped. The aneurysmal sac was excised and examined pathologically; no infectious etiology was found. Aneurysms at other locations were not operated. The association of vascular anomalies with d PICA aneurysms is discussed.

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