The frequency of angiographic demonstration of persistent primitive trigeminal artery (PTA) is 0.06 to 0.6%. It is well recognized that approximately 13.8 to 27.8% of patients with PTA also have intracranial aneurysms. However their association with the contralateral occluded internal carotid artery (IC) has not been reported. We reported such an extremely rare case of PTA associated with multiple cerebral aneurysms and a contralateral occluded IC. A 61-year-old female suffered from sudden onset of severe headache with nausea and vomiting. When she was admitted to our hospital, she complained only of headache with nausea. Computed tomography demonstrated a diffuse subarachnoid hemorrhage. Angiography showed a ruptured anterior communicating artery (Acom). Aneurysm and a left IC-PC large aneurysm with a broad neck. The angiogram also demonstrated a left PTA originating from the cavernous portion of the left internal carotid artery and ending at the midportion of the basilar artery and the contralateral occluded IC in the cervical portion. An operation was performed at day 3 using the left pterional approach, and the two aneurysms were successfuly clipped using the suction-decompression method. The patient was discharged with no neurological deficits.