Intracranial vertebral artery dissection is an uncommon but important cause of subarachnoid hemorrhage. These patients have a predilection for early rebleeding that makes early diagnosis and intervention imperative. The arterial dissection and associated dissecting aneurysm are often located close to the origin of the posterior-inferior cerebellar artery. Endovascular treatment techniques have been increasingly employed. An illustrative case that was treated successfully with coils but complicated by a posterior-inferior cerebellar artery territory infarction is presented. The objectives are to highlight the clinical features of this condition and to describe the problems associated with treatment, particularly those related to the posterior-inferior cerebellar artery origin.