An 82-year-old woman was admitted to the emergency department of a hospital with sudden-onset severe headache. Her past medical history included hypertension and hyperlipidemia, and she had undergone surgery 1 year earlier after SAH due to the rupture of a saccular aneurysm originating at the left internal carotid-posterior communicating artery. Postoperatively, she manifested no neurological disorders and she reported for regular follow-up of her unruptured intracranial aneurysms. Cranial computed tomography (CT) performed at admission revealed SAH (Hunt and Kosnik grade 2, WFNS grade 1,Fisher group 3) []. She was introduced to our hospital 4 days post onset. Three-dimensional CT angiogram (3D-CTA) and cerebral angiography showed bilateral PTAV and two aneurysms originating at the left side of the vessel. Comparison with the earlier studies showed that the size of the aneurysms had not changed and we were unable to identify the ruptured aneurysm. The patient manifested cerebral vasospasm and was placed under observation. Her condition remained good and she underwent surgery via a left lateral suboccipital approach on the 18th day post-SAH. The left PTAV penetrated the isolated dural foramen below Meckel's cave and lateral to the dorsum sellae []. Both aneurysms were visualized; one was saccular type at the proximal side and the other was fusiform type at the distal side. We concluded that the saccular aneurysm had ruptured. It was clipped and the fusiform aneurysm was clipped and wrapped []. On the 33rd day post-SAH, we placed a ventriculo-peritoneal shunt for hydrocephalus. Subsequently, her conscious level gradually improved and she was moved to another hospital for rehabilitation.