Ruptured Azygous Anterior Cerebral Artery (ACA) Aneurysm: A Report of Two Rare Cases

Aneurysms of the azygous anterior cerebral artery (ACA) are rare vascular anomalies, and their rupture is associated with significant morbidity due to bilateral frontal lobe involvement. Hereby, we present two cases of ruptured azygous ACA aneurysms with distinct clinical presentations and management approaches. In both cases, non-contrast CT revealed subarachnoid hemorrhage predominantly in the interhemispheric fissure. CT angiography and digital subtraction angiography (DSA) confirmed saccular aneurysms arising from an azygous ACA variant. One patient underwent successful endovascular coiling, while the other was managed via surgical clipping. Both patients demonstrated favorable outcomes with mild residual deficits. Early identification and appropriate management of this rare entity are essential for optimal neurological recovery.