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Background: Initial three-dimensional computed tomography angiography and cerebral angiography fail to identify any aneurysm in 20% of cases of subarachnoid hemorrhage. Basilar artery (BA) perforator aneurysm is rare and about 30–60% were not identified by initial angiography.Case presentation: A 71-year-old male was transferred with sudden onset of headache and loss of consciousness. Computed tomography demonstrated subarachnoid hemorrhage, but no ruptured aneurysm was detected. Repeatdoi:10.21203/rs.3.rs-1464238/v1 fatcat:je2ms7fdrzauhh5rlhi6a6ogny