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Introduction Aneurysm in intrameatal AICA are rare entity, that are very difficult to detect. We present one such case where patient got stroke treatment, complicated by subarachnoid haemmorhage.Case Description Patient (female, age 38) presented in emergency department with symptoms of posterior fossa stroke (nausea, womiting, difficulty moving right extremities, all of this preceded with pain in the right earlobe few days before). CT and CTA were performed, reporting no certain stroke signs; no large vessel occlusion or other significant vascular pathology was detected on CTA. After this IV rTPA was admitted, but unexpectedly, patient condition deteriorated severely and new ct was performed, showing posterior fossa subarachnoid haemorrhage centralized around meatus acoustic region on the right side. Now small aneurysm was identified in intrameatal segment of right AICA. Symptoms worsened, and decompressive craniotomy was performed. Control CT showed signs of infarction in right side of the brainstem, which was confirmed on MRI. Aneurysm was considered dissecting in etiology, and delayed deconstructive treatment with selective coil occlusion being performed. Patient gradually incompletely recovered with continuing rehabilitation for a long time period.Conclusions Intrameatal AICA aneurysm is a rare finding; once detected, diferent etiology such as mycotic or disecting aneurysm. According to presumed diferent etiology alternative treatment options should be cinsidered.Conflict of Interest No