We report a case of a ruptured aneurysm occurring at the peripheral bifurcation of the azygos anterior cerebral artery with fenestration at the unilateral horizontal segment, A
1. Further, hypoplasia was noted at the contralateral A
1. It is considered extremely rare that an aneurysm is complicated by such a combination of anomalies. Presence of these anomalies might significantly influence hemodynamics, and hemodynamic stress might play an important role in the occurrence and growth of an aneurysm.
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