Mirror aneurysms of the distal posterior inferior cerebellar arteries are extremely rare. We report a young female with bilateral aneurysms of the cortical segment of the posterior inferior cerebellar artery (PICA) with subarachnoid haemorrhage managed by microsurgical clipping of both the aneurysms in a single stage with excellent outcome. The management dilemmas and the risk factors of the mirror aneurysms of the distal PICA are also discussed.
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