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Acute subdural hematoma from ruptured posterior communicating artery aneurysm.
20) Selective pupil sparing can, however, pose a diagnostic dilemma, because it can occur with subarachnoid compressions, particularly due to posterior communicating artery aneurysm, affecting the inferior part of the 3rd nerve, a site that does not initially impact the pupillo-motor fibres located at its superior or medial margin.
My study points to the anterior communicating artery as being another dangerous location, but the numbers are too small to make a conclusion," Dr.
31,32) In the more recent study, aneurysms were categorized by the following locations--cavernous internal carotid artery, anterior circulation, and posterior circulation (including the posterior communicating artery origin) and by the following sizes: <7 mm, 7 to 12 mm, 13 to 24 mm, and >24 mm.
One patient had been referred to us from another unit where an attempt to clip a posterior communicating artery aneurysm had failed as the neck was heavily calcified.
A cerebral angiogram revealed a 5-mm anterior communicating artery aneurysm, which was obliterated by inserting endovascular coils.
The anterior communicating artery was the site of 27% of the aneurysms, the middle cerebral artery 17.
Giant posterior communicating artery aneurysm presenting as third ventricle mass with obstructive hydrocephalus.

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