<p>This case report describes a 29-year-old woman who experienced a spontaneous subarachnoid haemorrhage due to a left middle cerebral artery aneurysm rupture. The aneurysm was successfully coiled during cerebral angiography, which also revealed an unexpected finding of a right-sided aortic arch. The unforeseen finding of a right aortic arch prompted curiosity as to whether there is a physiological and/or anatomical relationship between a right aortic arch and left cerebral aneurysms. A literature review was conducted and revealed that there is no existing case report of a right-sided aortic arches being associated with a cerebral aneurysm. Furthermore, there is no literature describing a physiological relationship between right aortic arches and left cerebral aneurysms. The literature search did yield, however, some important anatomical variations of the aortic arch and its associated complications. Furthermore, vascular variations related to cerebral aneurysms were also explored and detailed. Considering this, understanding aortic anatomy variations and its related complications is important. Furthermore, when treating cerebral aneurysms, it is important to consider underlying or associated vascular anomalies. In conclusion, this case highlights the importance of maintaining clinical alert of anatomical variations and appropriately investigate and treat its associated complications. In addition, one should maintain clinical suspicion of associated or underlying pathologies when treating the presenting disease.</p>