{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T22:56:00Z","timestamp":1788389760948,"version":"build-2803163510"},"reference-count":27,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T00:00:00Z","timestamp":1766620800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy Carol Davila"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Although rupture of aneurysms at the internal carotid-posterior communicating artery (ICA-PCom) junction accounts for a small percentage of all ruptured intracranial aneurysms, they are clinically relevant due to their proximity to perforator-rich cisterns, the optic-carotid-oculomotor pathways and flow-diverting zones, as well as their high likelihood for causing early neurological instability. Additionally, ruptured ICA-PCom aneurysms that have multiple lobulations are associated with increased variability in wall shear stress, local inflammatory remodeling and higher propensity for rupture at smaller sizes compared to other types of aneurysms. Due to the rapidity of early physiological destabilization in most patients with ruptured ICA-PCom aneurysms, clinical\u2013anatomical correlations in these cases are often obscured by neurological deterioration; therefore, the presentation of this patient provides a unique opportunity to correlate the minimal early symptoms, tri-lobulation of the aneurysm and confined cisternal hemorrhage, to better understand rupture behavior, surgical decision-making in an anatomically challenging area, and postoperative recovery. Case Presentation: A 48-year-old hypertensive female experienced an acute \u201cthunderclap\u201d headache accompanied by intense photophobia and focal meningeal irritation, but, unexpectedly, retained a normal neurologic examination. She did exhibit some minor ocular motor micro-latencies, early cortical attentional strain and lateralized pain sensation that suggested localized cisternal involvement despite lack of generalized neurologic impairment. Digital subtraction angiography and three-dimensional CT angiography revealed a ruptured, tri-lobulated aneurysm originating from the communicating portion of the left internal carotid artery proximal to its origin from the posterior communicating artery, oriented toward the perimesencephalic cisterns. The aneurysm was surgically clipped using a standard left pterional craniotomy with direct visualization, after careful dissection through the carotid and optic windows to preserve the anterior choroidal artery, oculomotor nerve, and surrounding perforators. The neck of the aneurysm was reconstructed with a single straight clip, without compromise to the parent vessel lumen. The patient had an uneventful postoperative course without vasospasm or neurologic deficit. At both 3 and 9 months postoperatively the patient remained free of clinical neurologic deficit, and imaging demonstrated continued aneurysm exclusion, preserved ICA-PCom anatomy, and no evidence of delayed ischemic injury or hydrocephalus. Conclusions: The goal of this report is to demonstrate how a ruptured, morphologically complex ICA-PCom aneurysm may present with preserved neurologic function, thereby enabling the study of clinical\u2013anatomical associations before secondary injury mechanisms intervene. The relationship between the configuration of the patient\u2019s symptoms, geometry of the aneurysm and pattern of hemorrhage within the cisterns offers insight into a rare rupture pattern observed during routine clinical experience. Through complete anatomical analysis, timely microsurgical reconstruction and consistent follow-up, the authors were able to achieve long-term recovery of this particular patient. Continued advancements in vascular imaging techniques, aneurysmal wall modeling, and postoperative monitoring will likely help clarify the underlying mechanism(s) responsible for such presentations.<\/jats:p>","DOI":"10.3390\/diagnostics16010073","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T02:07:58Z","timestamp":1766714878000},"page":"73","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Ruptured Tri-Lobulated ICA\u2013PCom Aneurysm Presenting with Preserved Neurological Function: Case Report and Clinical\u2013Anatomical Analysis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6296-8364","authenticated-orcid":false,"given":"Stefan","family":"Oprea","sequence":"first","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9043-3690","authenticated-orcid":false,"given":"Cosmin","family":"Pantu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Breazu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Octavian","family":"Munteanu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian Vasile","family":"Dumitru","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Pathology, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 030167 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mugurel Petrinel","family":"Radoi","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Costea","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Neurosurgery, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andra Ioana","family":"Baloiu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Anatomy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Doctoral School, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Puls Med Association, 051885 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1007\/s00134-024-07387-7","article-title":"Contemporary Management of Aneurysmal Subarachnoid Haemorrhage. 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