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Dissections of intracranial arteries are rare and occur most commonly in the vertebrobasilar system.1 Isolated dissecting aneurysms of the posterior cerebral artery (PCA) are very uncommon. We report a case of subarachnoid haemorrhage (SAH) heralded by a 3-month history of diplopia due to dissection of the right PCA documented with digital subtraction angiography (DSA), magnetic resonance imaging (MRI) and angiography (MRA). The patient was treated conservatively, with a good outcome.
A 58-year-old male farm worker was found unconscious in the countryside and admitted to hospital. His medical history was unremarkable except for treated arterial hypertension and diplopia for 3 months. On admission, he had a Glasgow Coma Scale (GCS) score of 14 and a complete right third-nerve palsy. Vision and corneal reflexes were normal. A computed tomography scan showed diffuse SAH and intraventricular haemorrhage with hydrocephalus (fig 1A). Soon after arrival, he became less responsive and underwent temporary external ventricular drainage. DSA disclosed a fusiform dilatation of the P1–P2 segment of the right PCA with a focal “blister”, suggesting a dissecting aneurysm (fig 1B).