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Figure 1: CT head shows right frontal hematoma with intraventricular extension (A). DSA (right ICA injection, lateral view) shows both ACA arising as a common trunk (azygous ACA) along with ophthalmic artery from paraclinoidal ICA (arrow, B). A mycotic aneurysm was seen in a cortical branch of right ACA (arrowhead, B). 3-D angiogram clearly delineates the infraoptic azygous ACA (arrow, C) and the aneurysm (arrowhead, C). Left common carotid injections reveal hypoplastic left ICA (arrows, D). Left vertebral artery injection shows left posterior communicating artery opacifying the middle cerebral artery. CT scan through base of skull shows hypoplastic left carotid canal, confirming congenital hypoplasia of left ICA (arrow, F)

Figure 1: CT head shows right frontal hematoma with intraventricular extension (A). DSA (right ICA injection, lateral view) shows both ACA arising as a common trunk (azygous ACA) along with ophthalmic artery from paraclinoidal ICA (arrow, B). A mycotic aneurysm was seen in a cortical branch of right ACA (arrowhead, B). 3-D angiogram clearly delineates the infraoptic azygous ACA (arrow, C) and the aneurysm (arrowhead, C). Left common carotid injections reveal hypoplastic left ICA (arrows, D). Left vertebral artery injection shows left posterior communicating artery opacifying the middle cerebral artery. CT scan through base of skull shows hypoplastic left carotid canal, confirming congenital hypoplasia of left ICA (arrow, F)