Objective: Treatment for ruptured dissecting aneurysms of the vertebral artery (VA) varies according to the origin of the posterior inferior cerebellar artery (PICA). However, a PICA originating from the V3 segment has not been reported.Case Presentations: A 49-year-old man with a World Federation of Neurosurgical Societies (WFNS) grade III subarachnoid hemorrhage developed headache and bilateral lower limb weakness. Computed tomographic angiography revealed a right hemorrhagic dissecting aneurysm of the VA at the V4 segment, with a PICA originating from the V3 segment. On the day after endovascular coil embolization of the parent artery, magnetic resonance imaging (MRI) identified ischemic complications of the lateral medullary, ipsilateral cerebellar hemisphere. He had no other complications and was transferred to a rehabilitation hospital with modified Rankin scale (mRS)4.Conclusion: Considering the origins of the PICA and anterior spinal artery (ASA) is important when selecting treatment for hemorrhagic vertebral artery dissecting aneurysm. The morphological features of aneurysms, such as that described herein, are challenging, and perforated vessels might become occluded and initiate ischemic complications.