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+A 58-year-old man with a past medical history of poorly controlled hypertension and type 2 diabetes, presented to the ICU for a cardiogenic shock complicating acute myocardial infarction.
+Physical examination revealed reduced level of consciousness (Glasgow Coma Scale 10/15) and weak vital signs; a blood pressure of 80/50 mmHg, 80% of oxygen saturation, capillary blood glucose at 2.26 g/L, a heart rate over 125 bpm, and crackling in pulmonary auscultation.
+Cardiovascular examination showed neither cardiac murmur nor signs of right heart failure.
+ECG on admission showed normal sinus rhythm, with heart rate of 125 bpm and extended ST-elevation in anterior territory.
+Laboratory results demonstrated Troponin I level of 6.41 ng/ml, creatinine kinase (CKMB) was 67 UI/L, Lactate deshydrogenase was 281 UI/L, glucose level 2.70 g/l, urea 0.40 g/l and creatinine 18.6 mg / L.
+The patient was intubated and sedated, inotropic agents were started (norepinephrine 0.4µg/kg/min and dobutamine 20µg/kg/min).
+Chest X-rays showed diffuse alveolar syndrome.
+Transthoracic echocardiography revealed wall motion abnormalities namely extensive akinesis of anteroseptal, anterior, lateral and inferior walls, and severe left ventricular systolic dysfunction (ejection fraction of 29%).
+Medical management was initiated; anticoagulant therapy for acute coronary syndrome was started (500 mg of acetylsalicylic acid and subcutaneous low-molecular-weight heparin (0.6ml of enoxaparin)) and patient was prepared for myocardial revascularization by coronary angioplasty.
+Because of non-improvement of neurological status and occurrence of seizures, a brain CT was indicated and revealed infratentorial diffuse hemorrhage (Fisher grade III) (Figure 1).
+Cerebral angiography confirmed a dissecting aneurysm of an anastomotic branch between left PICA and the V4 segment of left vertebral artery Figure 2 that was successfully embolized.
+After 24 hours, the patient improved with withdrawal of vasoactive drugs in 24 hours.
+Left hemicorporeal seizures persisted despite anticonvulsant treatment.
+Control brain CT did not report rebleeding and angiography showed complete exclusion of the aneurysm while the EEG revealed a diffuse brain damage.
+10 days after admission, the patient was discharged in stable condition but still suffers from amnesia.