Recurrent subarachnoid haemorrhage from an angiographically occult large distal pica aneurysm

Abstract

The author reports an unusual case with recurrent episodes of subarachnoid haemorrhage. Complete angiographic examination was negative on three occasions. An unexpected distal posterior inferior cerebellar artery aneurysm was found at autopsy. The case illustrates the occasional failure of angiography in the detection of aneurysms and the need to have a high index of suspicion of an aneurysm in cases with recurrent subarachnoid haemorrhage with negative angiography. The role of magnetic resonance imaging is discussed.

Key Words:

• Distal PICA aneurysm
• negative angiography
• rebleed
• repeat angiography
• subarachnoid haemorrhage