Purpose <p>This study aims to present a rare case of total bilateral duplication of the posterior communicating artery (PComA), which has been infrequently documented in the literature, and to discuss its anatomical and embryological implications.</p> Methods <p>We describe the case of a 45-year-old woman who underwent Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) for sudden onset tinnitus, revealing incidental findings of a dual fenestration of the right A1 anterior cerebral artery (ACA) and an azygos A2 ACA pattern. Notably, total duplication of the PComA was discovered bilaterally, confirmed by Computed Tomography Angiography (CTA). The posterior cerebral artery has a bilateral adult configuration. Follow-up imaging over five years showed stability without aneurysm formation.</p> Conclusions <p>This case represents the first documented instance of bilateral total duplication of the PComA in an adult, revealing significant anatomical variations. While total PComA duplication is rare, previous studies have associated unilateral duplication with an increased risk of aneurysms. Our findings emphasize the necessity for further research into potential clinical implications and the need for long-term imaging follow-up in such cases, despite the current absence of pathological significance in this particular instance.</p>