A 57-year-old daycare educator presented as a drowsy but oriented individual with a history of sudden and severe headache associated with vomiting. She had no previous medical or neurological history. Examination showed no focal signs and routine laboratory studies were unremarkable. Head computed tomogram (CT) revealed a Fisher grade IV subarachnoid hemorrhage in the posterior fossa with extensive intraventricular hemorrhage (Graeb 8/12, see Figures 1A and 1B) which was shown to originate from

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... a left Posterior Inferior Cerebellar Artery (PICA) aneurysm on CT angiography and treated successfully with endovascular embolization. Five days later she deteriorated her level of consciousness (Glascow coma scale [GCS] 8/15). The CT scan showed moderate hydrocephalus and a ventricular drain was placed. She improved clinically but remained disoriented with slowed information processing skills.